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III PLANNING AND DEUEI:OPNLENT SERVICES DEPARTMENT
BUILDING.AND CODE REGULATIONS:DIVISION
t 2300�ZRGINFA A IK , }
FORT JERCE,FL 34982
. ,_•_ _.Yam. - - (772)452 1553 Fax;(772a 462 t578'
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= 1PERNII2 RENEWAL.REQUEST' ,. :
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PERNiIT'NUMBER M04-0518 ppDR ss 2325 Oaks-Dr, Ft. Pierce; FL 34949 _
`I,`Curtly Sammons _._ ,am zequesting that�Tfhe above permit be renewed I
understand that I must schedule and.pass.all rc,�ulrel'InsrecUons for'the permit to be fnaled Further, I,
understand that this:Is a ONE TIME RENEWAL aril the perMg'shall expire.should l mot,rece m a
passing tnspection during=any six month period during the renewal'penod.
Justifcation'Nnat sure what happened #hlnk a couple got misfiled_, T
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C/�1 r. e�—/� ^7 D7gilaliy agnad by Cures Sammo!ia p ee�� rr
UI'f�3 S,GII'IIllQP1S; #Dato:202410825t54230-0!'OQ_' 8 25'000O
DWNERBLDR OR CONTRACTOR SIGNATURE- DATE'
Curtis Sam%nons:
'Pnnt:Naine
STATE OF FLORIDA: ,
GO,3NTY OF iS rude__.
ACKNOWLEDGED BEFORE ME THIS'25 _ _ DAY OF Al1gUSt �p 20_Y r
Bl, :GUrttS'SaCT]rltOnB, WH0 IS PERSQNALLY;KNOWN TOME yeS
HAS.,PROVIDED,, AS;lDENTIF1CtCTION'.,
77
ST OF FLORID busty of Saint IUCIe' _
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i _ i E + *�1_CONd1S31pIdfGG�S;
5 NATURE OF N .T:4RY SEAL � ,qow
1►�yy_- ���y5 2Q21'
n
FOR OFFICE-tSE-.ONLY'
zNumber o£O;pen Inspections:;... _..
Totailnsp'ddions _
{Divide open ny toto..V get°o"of open-inspections)
. ,Percentage _
On final„ermitfee x%'o en=ti $ _ Renewalfee
Example �il S d!nded by 23 65(°l0)] $175fpermit.fee),x.fiS $„113 75(renewal,f_ee)'
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