HomeMy WebLinkAboutPERMIT RENEWAL REQUEST-I
PLANNING AND DE
BUILDING AND
(772)
SCANNED
BY
St dude County PEIV
0.
PERMIT NUMBER: G o�� ADDRESS;
I, TQ/Z�C , am regi
understand that I must'schedule and pass all required i1
understand that this is a ONE TIME RENEWAL and
passing inspection during any six month period during
Justification
G�
�pWNER/BLDR OR CONTRACTOR SIGNATURE
pg,v lAe
Pfint Name
STATE OF FLORIDA &J,
COUNTYOF
ACKNOWLEDGED BEFORE ME THIS DAY OI
BY � WHO IS
HAS PROVIDED _
ST OF FLO County of I OLVII f
SIGN OF NOTARY
FOR OFFICE USE ONLY:
PMENT SERVICES DEPARTMENT
E REGULATIONS DIVISION
VIRGEWA AVE
PIERCE, FL 34982
B Fax (772) 462-1578
RENEWAL REQUEST
mg that the above permit be renewed. I
ctions for the permit to be finaled. Further, I
permit shall expire should I not receive a
renewal period.
d /- `I �41�
DATE
20 j /
Y K TOME.OR
AS IDENTIFICATION.
#9 P4 i+ Notary Public State of Florida
? Frances Donza
c My Commission GG 092440
'moo,v SEyffires 07/27/2021
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=$1�13.75 (renewal fee)
Revised 7/21/2014