HomeMy WebLinkAboutPermit Renewal Req. - Debus, PetePLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRG INIA ANT.
FORT PIERCE. FL 34982
(772)4624553 F.(7721462-1578
PERMIT NUMBER: 2103-0339
PERMIT RENEWAL REQUEST
ADDRESS: 9826 Carlton Rd
1 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 tingled. 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.
cAmx /j�[.f �O 3/10/22
O •RBLD R CONTRACTOR SIGNATURE DATE
Cheyenne Ellison
STATE OF FLORIDA
COUNTY OF �n
ACKNOWLEDGED BEFORE ME THIS 10 DAY OF March 2022
,y Cheyenne Ellison WHO IS PERSONALLY KNOWN TO ME x .OR
HAS PROVIDED
AS IDENTIFICATION.
STAT
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SI
OT
SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total in get % ofopen inspections)
Percentage:
Original permit fee: x % open = S Renewal fee
Example: [I5 divided by 23=.65(%)] $175(permit feel x .65=$113.75 (renewal fee)
Revised 7/21/2014
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