HomeMy WebLinkAboutPermit RenewalsPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
• FORT PIERCE, FL 34982
(772 462-1553 Fax (772) 462-1578
RENEWAL REQUEST
PERMIT NUMBER: 2109-0542 ADDRE4S: 4160 N Highway A1A Unit 902A
I Shyan Wojtczak , am
understand that I must schedule and pass all requir
understand that this is a ONE TIME RENEWAL
passing inspection during any six month period du
Justification I thought it was already inspected
iCTOR SIGNATURE
Shyan Wojtczak
Print Name
STATE OF FLORI A
COUNTY OF \�
ACKNOWLEDGED BEFORE ME THIS k�Y DAY OF
BY �)V14C(.n 0 WHO IS PERS
HAS PROVIDED
L,
STATE OF FLOR,21),),` County of "j - Ii41C.1
p
SIGNATU OF ARY
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 = $
Example: [15 divided by 23=.65(%)] $175(permit fee) x
Revised 7/21/2014
luesting that the above permit be renewed. I
inspections for the permit to be finaled. Further, I
d the permit shall expire should I not receive a
the renewal period.
12-14-21
DATE
20
ALLY KNOWN TO ME , OR
AS IDENTIFICATION.
A � Micheal MOMRIVo
Q
Notary Public
SEAL o o State of Florida
: Comm# HH02567 .
;NCE Aq Expires 7/30/2024
fee
113.75 (renewal fee)