HomeMy WebLinkAboutrenwal requestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 1712-0317
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 8208 Lakeland Blvd.
I Raquel Swanner , 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 Scheduling conflicts with customer
Name
STATE OF FLORIDA
COUNTY OF _ ______
ACKNOrW�L�EDGED BEFO/RE� ME THIS �_ DAY OF ��i � , 20��.
BY I`�A(�i (n,Z' �-�r v�+�� WHO IS PERSONALLY KNOWN TO ME � OR
��
HAS PROVIDED _... ____ �,�5<IpT� rr,N
STATE
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 7/21Y1014
JONAI'HON TFIOMAS
MY COMMISSION it HH 144714
EXPIRES: September 10, 2025
Bonded Thm Notary Publiz Undervirite�.
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