HomeMy WebLinkAboutPermit Renewal RequestBUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT NUMBER: SLC-2008-0686
PERMIT RENEWAL REQUEST
ADDRESS: 7200 Roberts Rd.
1, Wayne T. Burnett , 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 We were not able to complete a final inspection prior to the permit expiring.
The jo�Komplete and we are ready to set the inspection.
CONTRACTOR SIGNATURE
Wayne T. Burnett
Print Name
STATE OF FLORIDA
COUNTY OF St Dude
ACKNOWLEDGED BEFORE ME THIS Z PM DAY OF
BY WMMr: T- 13VeMIM
HAS PROVIDED
STATE OF FLORI A, Countyof :ST. LVU
51GNATUR F I"JOIWRY
FOR OFFICE USE ONLY:
3/26/2021
DATE
0aP-06i
.20 I
WHO IS PERSONALLY KNOWN TOME , OR
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.
SARBARA ESPAI�
Notary Public- State of Flo0da
-A1Coouaisslon 8 GG 985888
µy Comm. Expires Aug 30, 2024
!dthrough National Notary Assn.
Example: [15 divided by 23 .65(%)) $175(permit fee) x .65 $113 75 (renewal fee)
Revised 7-21'2014