HomeMy WebLinkAboutPermit Renewal Request 4919 Pinettree Drive PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
' - - BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2006-0879 ADDRESS: 4919 Pinetree Drive, Fort Pierce, FL 34982
I Kevin R. Matyjaszek ,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 Issues with gaining access for inspection related to the COVID-19 pandemic and
Florida Governor DeSantis Executive Orders 20-52 and 20-316.Will obtain final inspection within two weeks.
OWNER/BLDR CO TRACTOR SIGNATURE /DATE'Kevin R. Matyjaszek
Print Name
STATE OF FLORIDAj
COUNTY OF UUI
ACKNOWLEDGED BEFORE ME THIS��DAY OF Ua f\ 20 4 i
BY ��111r1 I� Y"WT���US�ie.�WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STA OF FLORIDA,County of CHARMAINE CNENAULT
MY COMMj;SION#GG 847824
GNATURE OF NOTARY SEAL '�rg c�°` EXPIRES:April 24,2021
°F ,• Bonded nvu Notary Public Underwriters
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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: L15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014