HomeMy WebLinkAboutPermit Renewals • 0
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
e • 9 2300 VIRGINIA AVE
FORT PIERCE FL 34982 3.
y
(772)462-1553 Fax(772)462-1578 n,
PERMIT RENEWAL REQUEST 0 d
,
PERMIT NUMBER: 1910-0281 ADDRESS: 1220 NW Winters Creek Rd,Palm City,FL,34990
I, KOH KNOX ,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 ENGINEER HANDLING ALL INSPECTIONS,ROOF COMPLETED JUST NEED PASS INSPECTIONS
PERMIT EXPIRED.
4/20/2020
OWN DR OR a00ACTOR SIGNATURE DATE
KOH KNOX
Print Name
STATE OF FLORIDA
COUNTY OF COLLIER
ACKNOWLEDGED BEFORE ME THIS 20 DAY OF APRIL 2020
BY KOH KNOX WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF_"FLORIDA,County of COLLIER H- M
IKEN GRACE 0 KEEFE
Public-5tate of F{orida
missionGG 307994
m.Expires Mar 5,2023
SIGNATURE O OT SEALgh National Notary Assn.
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