HomeMy WebLinkAboutPermit Renewals (2) PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1803-0457 ADDRESS: 5005 FORT PIERCE BLVD, Fort Pierce
I Roderick Waller ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six.month period during the renewal period.
Justification Customer had health issues
3/26/20
OWNER/BLD4 OR CONTRACTOR SIGNATURE -DATE
Roderick Waller
Print Name
STATE OF FLORIDA
COUNTY OF Sc Lucie
ACKNOWLEDGED BEFORE ME THIS 26th DAY OF March 2019
BY Roderick Waller 0 IS PERSONALLY KNO TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLOPI DA2Co n f St Lucie
Notary pubiie StaN of fbrida
ON Sophia Harris
§IGNATURE OF NOTARY S My f:memi"m GG 235873
Expires 05d3012020
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014