HomeMy WebLinkAboutrenewttOC, NTY
F L 0 R[ pA
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 2103-0589
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 38 Sovereign Way
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 house is being built a cannot install generator yet
OR
SIGNATURE
'0l0yix-1 EaK Mon
Print Name
STATE OF FL A
COUNTY OF
DATE
ACKNOWLEDGED BEFORE ME THIS 1 � � DAY OF 1 - W�` � 20
BY "4�I I J� (� (V WH S PERSONALLY KNO 0 ME , OR
HAS PROVIDED AS IDENTIFICATION.
ATE OF FLORIDA, County
ATURE OF NOT
PRYF�c,' DANIELLEGONCALVES
MY COMMISSION # GG 232946
EXPIRES: hne 272022 dd
_9 1
AB,onded Thru Notary Public Underwriters
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R 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