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F,ILAN'NING,AND,DEIVEILOP.MEINTSrlRVICEISDEIPARTACI-NT
BUDDING AND CODE ft,VLATIONS DIVISION
A41ORG X—M, - -
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(772),462-1553; )Fair (772)4624578
PE RYATRENEWAL REQUEST
PERMIT. NUMBER: 0-6 0 QRES8: /V! 4-).
~,.ain requesiffigthatihe abovepemuibc.'renew-ad, I'
nderstand,that.1mustschedule and p' Hnspeotions,for th- - ep6ftnitAohe,fmabbd. Fift-ther,
pass =qdiiec
aderstAhd, that this is, -.a ONE TIMB RE-NEMXLand the v&rftiffsh6ll �explre'it should lnotxodclv6'a
- ,
passing mispelotion "durviag any six Iff0rittl pen-9d
Justification
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6WER?=R. OR CONTRACTOR SIGNATURE DIAT
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ACKNOWLEDGED BEFOWMEIMS. DAY' C* 20
/4c-,,,,t,-((;"--- VulolspBlzSO14AL,.L4KNOWN TO U O
HA§ PROVIDED A$ TD NTIFICAnom
90OPER of r SANDI'COOPER
STATE or M6Q. Comity (l?, .-JR �-cp (-A� Notary Publl:c- State of Florldn
Fr 156
Commission
Ul,( My,0omrn.,ExplrwSep Z,20i9 1/229 $
EAL 0
SJGNATlqqOF NOTARY National
Notary
y
Bonded through National Notary Assn.
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vicE, USE -ONLY:
Number of Opercluspqclions:
Total Mspe I ctiobs'. I �!
OMdc open by total to get% ofopen inspections)`
Yercentage-
Original p �1-3x� IA open — $ A--160�16
.1 tf.onewal fee
Emuple: (!5lividdd.by23=,.65(% . )] ti75(-Prrmit Pee), x ;65410.15 (renmaL tee)
P,0scd'Vln014-
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AUG / 9 2017