HomeMy WebLinkAboutEXTENSION , ONE TIME- 60 DAYSPLANNING 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: 2107-0544 ADDRESS: 9960 S Ocean Drive, #1004, Jensen Beach, FI 34957
1 Jodi Bentley , 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 Due to delays with materials and man power issues we weren't able to start this project
as soopyps we thought. /
OVPl)1�R/BLDR OR CONTRACTOR SIGN E
_Justin Thiery
Print Name
STATE OF FLORIDA
COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS 10
BY Justin Thiery
HAS PROVIDED
STATE OF ORIDA, Court St Lucie
SIGNATURE OF N
FOR OFFICE USE ONLY:
DAY OF January
01 /10/22
DATE
2022
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.
MICHAELRAAZ
Commisslon # GG 318620
SEAL ����
Expires July 28, 2023
Bonded Thtu Budget Notary Services
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014