HomeMy WebLinkAboutPERMIT RENEWAL REQUEST PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COEJNTY
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1807-0715 ADDRESS: 3111 Avenue R Fort Pierce
I Roderick Waller ,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 Owner has financial issue to resolve.
1/29/21
"Juri�1 1 16 f I V I A06",
OWNER/BLDR O CONTRACTOR SIGNATURE DATE
Roderick Waller
Print Name
STATE OF FLORIDA
COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS 29th DAY OF January 2021
BY Roderick Waller WHO IS PERSONALLY KNOWN TO ME XX OR
HAS PROVIDED AS IDENTIFICATION.
FATE OF FLORIDA,County of St Lucie
r W,N ►WY Public 9WW of Fh'1
SIGNATURE OF NOTARY + ■ Eric H" E
my Com s c 913M
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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: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014