HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE SCANNED
FORT PIERCE, FL 34982 By
(772) 462-1553 Fax (772) 462-1578 ,
K Lucie court V
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1808-0554 ADDRESS: 312 Essex Drive, Fort Pierce
Roderick Waller , am requesting that the above permit be renewed. I
inderstand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
inderstand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
sassing inspection during any six month period during the renewal period.
ustification Customer had health issues
OR CONTRACTOR SIGNATURE
oderick Waller
int Name
ATE OF FLORIDA
IUNTY OF St Lude
10/17/19
DATE
CKNOWLEDGED BEFORE ME THIS 17th DAY OF October , 2019
I
Y Roderick Waller 0 IS PERSONALLY KNO TO ME OR
AS PROVIDED AS IDENTIFICATION.
ATE OF FLORIDA, CountmfjSt Lucie
ATURE OF NOTARY
OFFICE USE ONLY:
Imber of Open Inspections:
tal Inspections:
ivide open by total to get % of open inspections)
4fj400 Notary Public stall of Florida
Sophia Hams
Comma ion GG 23aa73
S " � 1T Expire 0513W2020
permit fee: x % open = $ Renewal fee
. [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
7/21/2014