HomeMy WebLinkAboutPermit Renewals 01/18/2018 17:18 FAX 7724606929 WILCO [a001
PLANKING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
COUNTY2300 VIROINYA AVE
FORT PIERCE,FL 34982
(772)462-Iss3 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERWT'NUMBER: 1705-0067 ADDRESS: 10701 S: Ocean Dr. Lot 633
x, ROBERT WILLIAMS am requesting that the above permit be renewed. T
understand that I must schedule and pass all required inspections for the pennit 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 mouth period during the renewal period.
Justification WORK LOAD HAS BEEN OVERLOADED DUE TO HURRICANE IRMA
1-18-2018
OWNER/BLDR QR CO CTOR SIGNATURE DATE
ROBERT WILLIAMS
Print Name
STATE OF FLORIDA
COUNTY OF Fl-owoA �( _
ACKNOWLEDGED BEFORE ME'TAIS ��DAY OF �J�1 1� ,20
EY 1+ dos, WHO 18 PERSONALLY KNO TO ME ,OR
HAS PROVIDED AS IDEN71FICATION.
TATI-OFF 0 A,County of �t Lucbu
s DAWN FIY 6RALD
JM COMMISSION#GO 1MM nk
SIGNATURE OF NOTARY `- ,� ErXPIRE3:DscCmbet t7;M
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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(0/6)) $175(permit fee)x_65=$1 13.75(renewal fec)
Revisc4 7/2iMi4
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