HomeMy WebLinkAboutPERMIT RENEWAL03/28/2019 11:11AM 772-287-3456 FERRELLGAS PAGE 01/02
PLANNING AND >pEVELOpMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA, AVE
SCANNED FORS' PIERCE, FL 34982
BY (772) 462-1553 FAX (772) 462-1578
St Ludo county I
P i RMIT RENEWAL REQUEST
r�
PERIL `f .. NUMBER: Q oC ADDRESS: 7
aril requesting that the above permit be renewed. I
understand that I trust 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 ex�zre should I not receive a
passing luspec, ti� dtuitlg any six znontlt period during the renewal period.
Justz;ficatiort .A .A ft1 A..)
gjO CTOR SIGNATURE � l7ATE
e-s
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGE)) i3EF0 TI�IS�DAY OF , zp
BY �aoial,16,1 R' O r° S WHO 1S PIsRSONALLY ICNOWN TOME , OR
FIRS PROVIDED %Z0 AS IDENTIFICATION.
OF
FOR OM, CE USE ONLY:
Niunber of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage: _
Original permit fee: X % open = $ -Renewal fee
J NE L. CONNER
Noqiublic State or Florida
Cosgmtssion # GG 0365070 20
My Comm'. Expires ORc 10,
National Notary Assn.
Example: [15 divided by 23=.65(%)] $175(permit fee) X ,65=$113.75 (renewal fee)
Revised 7/21/2014