HomeMy WebLinkAbout1004-0072 PERMIT RENEWAL REQUESTPLANNING AND DEVELOPM
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FORT PIE]
(772),
BY
SMUC1e Ciount ! PERMIT RENF
iT SERVICES DEPARTMENT
.gulations Division
IIA AVE.
FL 34982
1553
AL REQUEST
ADDRESS: Ili PERMIT NUMBER: 1�J /
I, / �l� \ G�/� , AM REQUESTING THAT THE ABOVE PERMIT IS
RENEWED FOR 18 MONTHS. I UNDERSTAND T HAT I MUST SCHEDULE AND PASS ALL
I
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
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PASSING INSPECTION DURING ANY SIX MONTHS PERIOD DURING THE RENEWAL PERIOD.
ER—MLDR ORICONTRAATURE DATE
STATE OF FLORIDA, County of /
ACKNOWLEDGED BEFORE ME. THIS S DAY OF .O ICI l 1 .20
BY c O I'S rPERSONALLY KNOWN TO ME , OR
HAS PROVIDED �L-. >I ����-� i�tb C'� AS IDENTIFICATION.
S-t
STTE OFFLORIM, County of ac-p—
SEAL
SIGNATURE OF 190TARY COMMISSION NUMBER
?. ; � Y GELA M. HUFF
MY COMMISSION # EE 083530
FOR OFFICE USE ONLY: EXPIRES: n112, 2015
bonded Thru Notary Public Underwriters
RENEWAL FEE: $ \ 1 •00 .
No. of Open Inspections _ Total No. of Inspections = (% of Open Inspections).
i
Original Permit Fee $ x Open Inspections $ (Renewal Fee).
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Example: [15 _ 23 = .65(%)] $175.00(permit fee) x .65(%) = $113.75 (Renewal Fee)
SLCPDSD REV 4/11/2011