HomeMy WebLinkAboutPERMIT RENEWAL REQUESTC907/-0-7�27
PLANNING ANID DEVELOPMENT SERVICES DEPARTMENT �0
BUILDING AND CODE IXGULATIONS DIVISION
2300 VI GINI.A, ANE
FORT FIERCE, FL 34982
SCANNED (772) 462-1553 Fax (772) 462-1578
BY
t, !L �oeonrty PERMIT RENEWAL REQUEST -SCANNED
BY
Sid, Lude count
PERMIT NUMBI±R_ i � 07 -0'7 )--'7 ADDRESS:
I, 0 am requesting that the above permit be renewed. I
understand tflifI roust sMiEdple 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 expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
�a,4
Print Name
STATE OF FLORIDA
COUNTY OF -Pu.l w% % e,a c %
WOWI-EDGEA BEFORE ME THIS 'Z (olh DAY OF � eta ���,.. �s� I` � ^, 24 1 g
WHO IS PERSONALLY KNOWN TO ME _le__, OR
PROVIDED
OF FLOM, DA, County of % 1 �n
AS IDENTIFICATION.
KWNEILWRPHY
C[J1tE � * *
OF NOTARY
Con nWon * 60133214
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eena.dneue�acnNal•ra
OFFICE USE ONLY:
fiber of Open Inspectiom-
i Inspections-
ide open by total to get % of open inspections)
permit fee:...,.... x % open $ Renewal fee
[15 divided by 23=.65(%)] S175(pe t fee) x .65-$113.75 (renewal fee)
7121/2014•