HomeMy WebLinkAboutPermit Renewals 01/18/2018 17:17 FAX 7724606929 WILCO fj001
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
"on vmC.WU AVE
FORT PIERCE,FL 34982
(772)462-1553 Pax(772)4624578
,PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1705-0065 ADDRESS: 10701 S. Ocean Dr. Lot 631
I,ROBERT WILLIAMS am requesting that the above permit be renewed. I
understand that I must schedule and pass all required ivaspections for the permit to be finaled. Further,l
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 WORK LOAD HAS BEEN OVERLOADED DUE TO HURRICANE IRMA
K 1-18-2018
OWN1 SWBLDR P)k RACTOR SIGNATURE DATE
ROBERT WILLIAMS
Print Name
STATE OF FLORIDA
COUNTY OF FLOMDA
ACKNOWLEDGED BEFORE ME THIS r_k-L DAY OF .20
BYt WHO IS PERSONALLY KNOWN TO ME _ ^,OR
I3AS PROVIDED AS IDENTIFICATION.
STATE OF 0 _.. County of ,S , � apt F1TL(3ERN.h
f�' s 16YCOWSSION0016M
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SIG ATUREOFNO ARY ,,� � Pu*kIvi
FOR OFFICE USE ONLY:
Numbef of Open Inspections:
Total Inspections:
CDivide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
'Example: [15 divided by 23s.65(°/u)] S175(permit fee)x_65=$113.75(renewal fee)
Revised 7/2112014