HomeMy WebLinkAboutPermitRenewalRequest2004-0157PLANNING 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: 2004-0157 ADDRESS: 216 Smallwood Ave
I, John Williams , 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 COVI D issues have delayed construction plans
and accessibilitv of materials needed.
P/__M'Z� 02122 t2ozl
WNERBLDR OR CONTRACTOR SIGNATURE DATE
John Williams
Print Name
STATE OF FLORIDA
COUNTY OF 5 f L (4 e— <
ACKNOWLEDGED BEFORE ME THIS ?_�L DAY OF 20_?/
BY Jc n W, I WHO IS PERSONALLY KNOWN TO ME,,N---, OR
HAS PROVIDED
STATE OF FLORIDA, County of
SIGN RE OF NOT
------------------------------------
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
AS IDENTIFICATION.
No" P AC 81a/a d FbrWa
Cindy Lou C3atdner
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Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014