HomeMy WebLinkAboutextPLANNING 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: 2104-0391 ADDRESS: 7827 Sabal Lake Dr
I Michael Flaxman , 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 House is under contruction by Difran Construction
OWNER/BLDR� OR tONTMCTOR SIGNATURE
N
Name
STATE OFF A
COUNTY OF ). Y l ,
) � ( P /�-�---
ATE
ACK�N/O�WLED�}G�E�D BEFORE ME THIS IS DAY OF r � L_ 20 c
BY '- l� ( 11.�C Q ) �—j� f ff�WH S PERSONALLY OWI�?TO ME OR
HAS PROVIDED
TE OF FLORIDA, County
V . ._A A (
OF NOTARY
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
AS IDENTIFICATION.
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
�',ANIELLE GJNGALVES
ti1Y CbMMISSION # GG 232946
EXPIRES: Jame 21.2022
Bonded Thru Notary Puhro U�Oerwn!•:Zs