HomeMy WebLinkAboutPermit renewal requestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
I BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGEWA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMrr N[JMBER: SLC 1903-0479 ADDRESS: 6206 Delwon Ave
I Juan Moran , 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 we thought permit was closed out and finaled
OR
Juan Moran
Print Name
STATE OF FLORIDA
COUNTY OF Indian Paver
SIGNATURE
ACKNOWLEDGED BEFORE ME THIS 9 DAY OF 17
PY Juan moran
HAS PROVIDED
9/17/20
DATE
2020
WHO IS PERSONALLY KNOWN TO ME X , OR
STATE OF FLORIDA, Coon of Indian River
SI A OTARY
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 — S Renewal fee
AS IDENTIFICATION_
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
MARIA COLIN
MY COMMISSION #GGD19569
EXPIRES: AUG 09, 2420
Bonded through Ist State Insurance