HomeMy WebLinkAboutPermit Renewals 10/16/2017 09:26 AM PDT TO: 17724621578 FROM:7724653252 Page: 3
i � 1
.J' Do
l 01�,u1-1—j
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
__ .._.... _......_._.. FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
1 PERMIT RENEWAL REQUEST
i
i
PERMIT NUMBER:1101-008$ ADDRESS: 100 IS 6 DUnes�V
I, James 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 End"are. Olpmp/4ed �ju�� pvicir -Fy tALrri Irma. elac
l r 0 str ' n del -Tfx b ls1 r "r Aeeded ror
�- � ,1Y�5•�LfiUI',
OWN BLDR O CONTRACTOR SIGNATURE DATE
01QJY)2S 1��a.n r�
Print Name
STATE OF FLORA +
COUNTY OF ,/�, ++__
I
ACKNOWLEDGED BEFORE ME THIS t3 DAY OF tSti'&he✓ 120 1'7
BY dames CZ. M-hr) WHO IS PERSONALLY KNOWN TO ME_V,`<R
HAS PROVIDED AS IDENTIFICATION.
TATE OFF RIDA,C my of�•
BRENDA JOAN ROONEY
NATURED NOTARY '' Con mission#FF 907848
._ ��d�
tvty'Ctffh'mission Expires
August 06, 2019
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(%)] $1 75(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014