HomeMy WebLinkAboutWillams - RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
# f 2300 VIRGINIA AVE
- FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: w— 0141 � ADDRESS: 55-0 i S
oU�
1, )n;Chr(.2J2 Uei5@—Ei)jjCX, am requesting that the above permit be renewed. I
understand that I must schedule and pass a 1 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 1 /157a1GZ,-I M
OWNER/BLDR OR CONTRACTOR NATURE D TE
Micme,1 14 SSwbbtl�
Print Name 1.1
STATE OF FLORI{�A
COUNTY OF S C• W u9-)
ACKNOWLEDGED BEFORE ME THIS�
' DAY OF Uc.((1 /20
BY 1" ((lW� e-L�J 1 PERSONALLY KNOWN TO ME V OR
HAS PROVIDED
ST46TE OF FLORIDA, County of.
SIGNATURE OF
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.
%'Vis
Shanon O'Shea
NOTARY PUBLIC
o STATE OF FLORIDA
? Comm# GG258038
Expires 9/12/2022
Example: [ 15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014