HomeMy WebLinkAboutPERMIT REMOVAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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PERMIT NUMBER: 2108-0135
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 2603 ROLYAT ST , FORT PIERCE, FL 34947
I, James Player 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 Homeowner/Customer ready to move fowrad
Revised bldg.
OWNER/1311�gk OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF E3[iadford
ACKNOWLEDGED BEFORE ME THIS OF 20 Z2.
13Y Li4MGS ICLAVE !� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA, County of R A"VFQ-P.,0 MARIAR. BURGIN
Commission#GG362849
` , 4 Expires August 25, 2023
SIGNATURE OF NOTARY SEAL
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 712112014