HomeMy WebLinkAboutPermit renewal ReqPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
zRT IER(EL\,349
— FORT PIt:R F. FL2)452
82
pR)J62-1553 Faa (]]'-)J62-157a
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2001-0263 ADDRESS: 0 Slash Pine Trail
1 Cheyenne Ellison 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, 1
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 Job not started yet
Cjge 11 /3/20
OW
NER/B05ROR CO�iT AIR SIGMTClRE f
Cheyenne Ellison
SLATE OF FLORIDA
COUNTY OF. —
ACKNOWLEDGED BEFORE METHIS 3 DAYOF November 2020
By Cheyenne Ellison WHO IS PERSONALLY KNOWN TO ME x .OR
I IAS PROVIDED AS IDENTIFICATION.
of rL'a anty of Martin
NvNry I blm SWW d I'ViCa
Desiree N .. Go 2
QF" My Cammismw CG 083399
SIGNATU ' N i R SEAL EXPIes'2e' 22
an
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get %ofopen inspections)
Percentage:
Original permit fee: x %open = S Renewal fee
Example: [15 divided by'_3=.65(%)] $175(permit fee)x.65=SI 13.75(reneaval fee)
R 1v 7121C0I4