HomeMy WebLinkAboutPermit Renewals MrM MNI PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
I BUILDING AND CODE REGULATIONS DIVISION
• 2309 VIRGDffA AVF,
FORT PIERCE,FI.3082
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST RECEIVED
JUL 0 9 2021
Sty 1-H®Ip Gedrdy
PERMITNUMI3ER: SLC 2008-0571 _ ADDpESS• 6375 S U S 1 ®emlttlfl�
I, John B. Utah _ am repestin*'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=RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
7/9/2021
Q " ONT CTOR SIGNATURE DATE
Sohn B. Mitala
Print Name --
STATE O1•FLORIDA
COUNTY OF Ift-ro
ACKNOWLEDGED BEFORE ME TwS 9th DAY op July ,7021
BY John B. Mitala WHO IS PERSONALLY KNOWN TO I%W X ,OR
HAS PROVIDED AS IDENTIFICATION_
STATE o)?FLORIDA,Coup ward �� '"r"'*. ROBERT THO"ADAMS
I�'. .1 Notary PUNC-State of Florida
Commisrian M HS 030591
SI ATURE O);NOTARY 813AL +h My Comm.Expires Au110,Z02�
Bonded through National Notary Assn.
FOR OMCE USE ONLY:
Number of Open Inspections;
Total Inspections:
(Divide open,by total to get%of open inspections)
Percentage:
Original pennit fee: _x%open = $ Renewal tee
Example: [15 divided by 23=,65(%)1 $175(permit fee)x.654113,75(renewal flee)
Revised 7/21/20)4