HomeMy WebLinkAboutPermit renewal 12-01-20;02:39PM; ;772-335-0860 #1 1/ 1
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
L � 1 . BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
—'-- --_ FORT PIERCE,FL 34982
(772)4624553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2005-0113 ADDRESS: 14219 Zorzal Avenue
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I, Jeff Jackman, Contractor ,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 Homeowner is seasonal resident from Canada. They were unable to
return to Florida until this month due to the Covid 19 restrictions.
11-15-2020
O OR NTRACTOR SIGNATURE DATE
Jeff Jackman, Contractor
Print Name
STATE OF FLORIDA
COUNTY OF st Lucia
ACKNOWLEDGED BEFORE ME THIS 15th DAY OF November ,2020
BY Jeff Jackman WHO IS PERSONALLY KNOWN TO ME X OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLOR A,County of St. Lucie y Sheryl D.Moore
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NOTARY PUBLIC
s STATE OF FLORIDA
SIGNATURE OF NOT omrn#GG945237
C6191 Expires 1/15/2024 �.
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
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