HomeMy WebLinkAboutPermit Renewal Request Brown HackEW
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2300 VIRGINIA AVE
FORT PIERCE, FL 34982
462-1553 Fax (772) 462-P
PERMIT RENEWAL REOM
PERMIT NUMBER: •0.0' 2 ADDRESS: 940 S. Ocean Dr. #706 BROWND/HACK
.I an 1 lcl , am requesting that the above permit be renevygd. I
understand that I must schedule and pass all required inspections for the permit to be finaledW Furt er,
understand that this is a ONE TIME RENEWAL and the permit shall ex ' should I not receive a
tustificatiois
assing inspection during any six month,period during the renewal period
a
2-2-22
.40
OW R/BLDR OR CONTRACTOR SIGNATURE DATE
Janet Milic�
Print Name .
so
STATE OF FLORIDA
.COUNTY OF MARTIN
ACKNOWLEDGED BEFORE ME TI Its 21R• DAY OF ' e �' "ft .20220
Mi
BY Janet Milici WHO IS PERS AL Kx
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I ICATI N.
S TE F FMARTIN
Notary Public State;207585
• : `F Donna Jayne Ha
SIGNATURE F N TA j
,P• My commission G2l
rya ad Expires 04m 512022
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open mspectlons
Percentage:
Original permit fee: ° p — $ .
Fxarrmnle- 115 divided by 23=.65(%)1 $175(nermit feel x .65=$1 13.75 (renewal fee
I /201