HomeMy WebLinkAbout2103-0786 - Renewal FormPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2103-0786 ADDRESS: 2626 Conifer Dr
1, James Brann , 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 waited on pool company to finish with pool before building enclosure.
OWNT7PLDR OR CONTRACTOR SIGNATURE
Ja es Brann
Print Name
STATE OF FLORIDA
COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS 7
BY James Brann
HAS PROVIDED
STA OF FLORIDA, Count�of StLucie
SIGNATURE OF NOTARY
FOR OFFICE USE ONLY:
DAY OF December
12/07/2021
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.
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
Notary public State of Florida
Despina Bone
My Commission HH 081902
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