HomeMy WebLinkAboutPermit Renewal Req. - Greco (Tippins)e PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
S BUILDING AND CODE REGULATIONS DIVISION
WVULOW 2300 VIRC E, F 349
- VE
FORT PIERCE, FL 2) 462
(772) 763-I553 Fax (]TSI463-15]N
PERMIT RENEWAL REQUEST
PERMIT NUNIHER: 2105-0096 ADDRESS: 19105 Okeechobee Rd
Cheyenne Ellison , 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 Was not informed that permit was expiring. If told, we would have
extended it. Job is not complete
CA 3/8/22
O BLD R CONTRACTOR SIGNATURE
Cheyenne Ellison
Print Name
STATE OF FLORIDA
COUNTY OF M—
ACKNOWLEDGED BEFORE ME THIS 8 DAY OF March 2,22
By Cheyenne Ellison WHO IS PERSONALLY KNOWN TO ME .OR
HAS PROVIDED AS IDENTIFICATION.
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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 = S Renewal fee
Example: [l5 divided by 23=.65(%)I EI75(permit fee) x .65=Si 13.75 (renewal fee)
Revised721R814