HomeMy WebLinkAboutrenewCOt11N'TY
F
L
L Q R[
D A
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 2103-0891
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 116 Island Dunes Cove
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 We just completed installation, had to wait on elevation cert to schedule final
OWNER/BLDR
Print Name
STATE OF FLO R
COUNTY OF
SIGNATURE
DATE
ACKNOWLEDGED BEFORE M( EE THIS
�n��ry DAY OF (a A 20"�)71
BZ'�(� ( lL��`l T K ZY1WH0 ERSONALLY OWN ME OR
HAS PROVIDED
TE OF 1
'\,
OF NOT
AS IDENTIFICATION.
DANIELLE GONCALVES
MY COMMISSION # GG 232946
rXPIRES: June 27, 2022
Banded Thru .1!otary Public Underwriters
-------------------------------------------------------------------------------------------------------------__---___
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