HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
�COUNTY
- { BUILDING AND CODE REGULATIONS DIVISION
LORI - 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)461-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2009-0092 ADDRESS: 6151 Arlington Way Ft Pierce FL 34951
I, Sherried O Watson ,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 Old permit tech left and I am taking over trying to close out all permits
May 13, 2021
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLORIDA O
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY C{ r {,,>!�. WG O1I—"0 IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF F A,County of r !,=-,'---•
CHRISTY WALTERS
$ MY COMMISSIONS GG 111239
SIGNATURE OF NOTARY SEAL EXPIRES:June 4,2021
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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