HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
_�i 2300 VIRGINIA AVE t.CtE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMITNUMBER: SLC2108-0340 ADDRESS: 2209 Jo Haywood Dr, Fort Pierce, Florida, 34946
I PAUL JUDSON , 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
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O ERB R OR CONTRACTOR SIGNATURE
PAULJUDSON
Print Name
3,18.2022
DATE
STATE OF FL013111A,
COUN"1'Y OF !lei YY ACKNOWLEDGED BEFORE ME THIS DAY OF M Q lc- %
BY 'C/L/ VU-E-COY
WHO IS PERSONALLY KNOWN TO ME ,�, OR
HAS PROVIDED
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.
�.PI N Notary Public State of Florida
x Ashley Dunne
SE yja NV MyP ommission l G 949276
Ex Ires01/21/2024
Example: [15 divided by 23=.65(o/u)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014