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From:Freedom Roofers Fax:(772)217-4459 -
Fax: (.772)462-1578 Page-I 2; 12/140-017 7:02 AM
PLANNING AND DEVELOPMENT SERVICES I)EPARTMENI'
BUILDING AND CODE REGULATIONS DIVISION
FORT PIERCE,1-1,34982
(772)462-1553 Fax(772)462-1578
I'LiaMIT RENEWAL REQUE I
i
PERMIT NUMBER: 1704-0396 _ ADDRESS. 3805 Arnold Rd, Pt. Pierce, FL 34981
1 Lee Dinenberg _ ,am requesting that the'above permit{be renewed. I
understand that l must schedule and pass all required inspections for the permit to be finaled. Further- [
understand that this is a ONE TIME RENEWAL and the permit shall expire should l not receive a
passim inspection during any six niontli period during;the renewal pe.r',iod.
Justification i would like to correct the problem
12/14I17 _--
iEI BLDR ,KCONTRACTOR St ,'ATC'It.F DATE
Lee Dinenberg
Print Name
i
S`rATF OF FLORIDA
C:OliNTYOF IndiarrRim
ACKNOWLEDGED BF ORL WI THIS 14 DAY OI December
BY Lee-Dinenberg I OR
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bVIiO IS PFRSC7i�ALl..Y i�NOWN'r(7 � _--_-•, )
HAS PROVIDED AS IDFiNMF1CA`rI6N,
S't F PI...ORIDA Co,xnt of
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- hV .' rission GF b232
_'ICiNA7- RF;OF NOTARY f y,�'i m.ExPi:esFeb23.20i1
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;wdMifhmuJnNffiion fNpiarfAisn
Annette McGrory
---__,.-.--------------------------------------------------------------------—--------__..--- -------------- -------------------------__
FOR OFFICE USE ONLY: - - I--
;Number of Open Inspections:�^
Total inspections: _
(Divide open by total to get%of open inspections) I
Percentage:
Original permit tee: x%open = $ _. Renewal fee .
Example: [15 divided by 23=.65("o)] $175(permit fee)x.65—$I 13.75(renewal fee)
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