HomeMy WebLinkAboutRENEWAL.PDFPLANNING 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
PERMIT NUMBER: 2103-0085 ADDRESS: 5710 TRAVELERS WAY
I, CHRIS SIDOTE , 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 PERMIT EXPIRED, HOMEOWNER HAS BEEN UNABLE TO GIVE US ACCESS DUE TO COVID.
�R CONTRACTOR SIGNATURE
CHRIS SIDOTE
Print Name
STATE OF FLORIDA `
COUNTY OF S - L.. rr G� •�
09/07/2021
DATE
ACKNOWLEDGED BEFORE ME THIS — - r% DAY OF S 7 eo 20��'�
BY WHO IS PERSONALLY KNOWN TO ME%,LO—R
HAS PROVIDED
STATE FLORIDA, ❑nty of
SIGNATURE OF NOTARY
AS IDENTIFICATION.
4Ypy4R
S1J5AN MONTENEGRo
.
YAgOMMISSION # HH 086984
EXPIRES: April2,2026
BOridad Thru Notary Public Underwrltars
----------------------------------- ----------------- -..-„- ------------------
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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: P 5 divided by 23=.65(%)] $175(pormit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014