HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2RT PI R PIERCE,
F 349
- VE
FORT PIERCE. FL 2) 462
(772)462-15i3 Fax (772)463-IS7B
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2108-0063 ADDRESS: 7848 Carlton Rd
I. Cheyenne Ellison , am requesting that the above permit be renewed. 1
understand that I must schedule and pass all required inspections for the permit to be foaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should 1 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
3/18/22
Cheyenne Ellison
STATE OF FLORIDA
COUNTY OF Mwa
ACKNOWLEDGED BEFORE ME THIS 18 DAY OF March 2022
BY Cheyenne Ellison WHO IS PERSONALLY KNOWN TO ME x .OR
HAS PROVIDED AS IDENTIFICATION.
STATE O
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SIGNATURE O S Desiree N McIntosh
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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. [15dividedby23=.65(%)j $175(permit fee) x.65=$113.75(renewal fee)
Revised 70I12014