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HomeMy WebLinkAboutSWEENEY permit Renewal.ExpiredPLANNING 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: Q?1� ©! 5 ADDRESS: �1 Thee-fO I, W 11 ha m U M M M . MS. .. , am requesting that the above permit be renewed. I understand that I must scHedule and pass all required inspections for the permit to be iinaled. 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 OR CONTRACTOR SIGNATURE DATE \66 III (I'm Dra ry\-kv Print Name [' Gl 1 hum (jn , 7 nL STATE OF FLORI COUNTY OF . "C-U. ACKNOWLEDGED BEFORE ME THIS S�ZDAY OF 2Q,21_ BY W 11 �a oI cn Q P6 WHO IS PERSONALLY KNOWN TO ME V/OR HAS PROVIDED AS IDENTIFICATION. STAyq OF FLORIDA, ounty of � '. L ,� NtY Pty� ROBIN K ADAMS `���r�` �' Commission # GG 341269 SIGNATURE OF N ARY S he Expires June 9, 2023 ppp�o Bonded TfxuBudgetNotary Services 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