HomeMy WebLinkAboutAlmo 4409 Renewal FormPLANNING 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. SLC 2010-0074 ADDRESS: 4409 Garner Ct
1, Douglas Roe , 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 Renewal to set proper inspections and close out permit.
to
OWNER/BLDR OR CONTRACTOR SIGNATURE
W.--
Print Name
STATE OF FLORIDA
COUNTY OF ffi�nlh'
Vv-
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DATE
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA, County of rllnr Ndory PutAic S I tato of Flodda
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4 'W- StWWk)n J Snft
My Coiftsslon HH 155978
SIGNATtlitfl6f-NOTARY SEAL Eore * OW312025
---- m ------------ m ----------- m --- m --- m --------------- mm-m ------ -------------- --m -------------- --m-m-m--mm ---------- m-m-mm--m-
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—$113.75 (renewal fee)
Revised 7/21/2014