HomeMy WebLinkAboutPermit Extension RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERbtI'INUNIBER: 2101-0381 ADDRESS: 8650 S OCEAN DR UNIT 1105
I, , 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 i a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection d ring any six month period during the renewal period.
h,@r; f;�ar;�„ PRODUC MANUFACTURER HAS EXPERIENCED SEVERE DELAYS AND HAS PUT PRODUCT
TO LATE JULY
SIGNATURE
STATE OF FL 7 A
COUNTY OF \ tiv
06/18/21
DATE
ACKNOWLEDGED BEFORE ME THIS �DAY OF L,J Uh,Cw - 20Z'
BY � �n � \MNtA WHO IS PERSONALLY I{NOWN TOME V / OR
HAS PROVIDED
STATE OF FbORIDA, CounTy of
OF NOTARY
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
AS IDENTIFICATION.
+ Notary Public Slate of Florida
aP� • Michael Viens
SEAL pf p� My Commission HH 028904
wand• EKpiras08l05/2024
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014