HomeMy WebLinkAboutPermit Renewal RequestDocuSign Envelope ID: AADF8198-51BE-4068-9949-E2IAACB17E8B
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
PERMIT NUMBER: SLC 2103-0654
PERMIT RENEWAL REQUEST
ADDRESS: 382 SE NARANJA AVE
1, Ronald Heath , 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 TEKE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification Manufacturers delay in receiving products
Er
e«wgew by:
v,A� �"t,a�{A,
OWNERBBLDR OR CONTRACTOR SIGNATURE
Ronald Heath
Print Name
STATE OF FLORIDA
COUNTY OF Bye
ACKNOWLEDGED BEFORE ME THIS 9
BY Ronald Heath
HAS PROVIDED
STX% OF FLORIDA,
. ANWA44
of Brevard
FOR OFFICE USE ONLY:
DAY OF November
11 /9/2021
DATE
2021
WHO IS PERSONALLY KNOWN TO ME x , OR
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.
IxEXPIRES
TAMMY BEER
MYCOMMISSION#GG173091
SEAL February 25.2022
Example: [I5 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7n1/2014