HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
� • BUILDING AND CODE REGULATIONS DIVISION
. R I A 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2004 -0181 ADDRESS: 9509 S Indian River Dr Ft Pierce FL 34982
I, Sherried O Watson ,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 Old permit tech left and I am taking over trying to close out all permits
May 13, 2021
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
S k",eo(-- o vL-
Print Name
STATE OF FLORIDA
COUNTY OF owwv2
ACKNOWLEDGED BEFORE ME THIS I3 DAY OF. 20�
BY J'W * i V VA�l3 Q' LWHO Is PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLO County of 0"t,
WAUEM
A myCOMMMSION O GG 111239
;," EXPIRES:.Une 4,2021
SIGNATURE NOTARY SEAL �:
.� .°i'.`• 8ond�d 7iru Nohry Pubic tllgNrRll�
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