HomeMy WebLinkAboutPermit renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
L COUNTYBUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1912 -0171 ADDRESS: 5681 Boca Chica Ft Pierce FL 34982
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
Print Name
STATE OF FLORIDA D 1 p
COUNTY OF if(-
ACKNOWLEDGED BEFORE ME THIS �J DAY OF 20
BY S�il:!'VL'I�c�. VUO►�t J G' WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED /� AS IDENTIFICATION.
o STATE OF FLO unty of O 1�/y,UlI� �.� �
CHR WWALTERS
SIGNATURE O NOTARY SEAL '° my comumm/Go 11,239
� �A:= EXPIR 3.Am 4.2021
�,• aV °' Bonded TAfu NdVy PWhk L*dW,1n
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=$1 13.75(renewal fee)
Revised 7/21/2014