HomeMy WebLinkAboutPERMIT RENEWAL REQUESTlou
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
';:COUNTY BUMI)ING AND CODE REGULATIONS DIVISION
2,300 VMGr4JA'AVE 111-1-6
FORT PB*F� FL34982 Oct I
M�) 46ii-.1553 Fax (772) 46:!�1578,
PERMIT RENEWAL REQUEST
PERMIT NUMBEW—Sk, 2C��AAl. ADDRM.1
-TL W--
thAtAlm b-,---
a ove-pprmit berenewed.t ass a required 1 jo�i4sch6duleAndp' �fll— -',.odiiasp-ecfio'-U--Sfo-rthei:.,p.L-Mittdbi�-fifialdd. Rkh-ch,1
iiiderstizid Alsis a ONE-TEME-RENEWALand the,6crinit ipife- sh6ifld I li& r6b ------ I i — .
shall d eive a
imridterst'!aVddV
,i6t
passing jppecfiqn i-,qiy- six mankpeno wring the renewal peri6dt'
... tion .... .. . AX-MA k 'IRA
fY
OWNERIBL-WIIPLR2CONMAPTOR'SIGNA�T�E-
DATE
f4pla
Print Name
STATE OF FLG%A
COUNTY OF
ACKNOWLEDGED BEFORE LIE DAY OF
WHO ME OR
B 14� `
Y L- lz� --
HASPROVIDED,
AS IDENTIPICATION.
STATE OFFL(J-*-A RID—County,of. "F5,�-", ..1
BRITTANY R
'FIC—NATURE OF liqF2AR-Y
tal�e of:EQDIN, II
F1ocidarNqi,ar.y* Public.II imission#GG-190282,
W -
cpn
My_ 0mrni-ssion Expirq�-,
Febr
ubry26,2022
FOR OM&USE ONLY:
Number of Open Inspections:
(Divide open by total to get Wof open inspections)
Pdrcentag6,-,
Original perwml ie;:F �x a open = $ Renewal fee
Example- [15divided by23=.65(%)]*$l-75(painit fee) x.657-7$113.75 (renewal fee)
Revised M112014