HomeMy WebLinkAboutPiersonC077 ,
F L D R I D A
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 2007-0459
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 6043 Alexandria Cir
I Michael Flaxman , 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 No justifiable reason, the final inspection was never done
OWNER/BLDR
SIGNATURE
I�. (1' a )J
Print Name F
DATE
STATE OF FL Q,
COUNTY OF I - �{
ACK OWLEDGED BEFORE ME THIS '\j�~ DAY OF A-
20 �
BY n /� Y I WHO IS RERSONALLY KNO TOME OR
HAS PROVIDED
TATE
SIGNATURE 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.
DANIELLE GONCALVES
MY CbMMISSION # GG 232946
OWS: June 27, 2022
Bonded Thru Notary Public Underwriters
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014