HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 RCCCI�/ED
(772)462-1553 Fax (772)462-1578
MAY 2 8 2019
PERMIT RENEWAL REQUE
t,urwfe County, permitting
PERMITNUMBER: MCI - O2(o-7 ADDRESS: 2.%O q SOujA, 22" 5�
kI am requesting that the above permit be renewed. I
.1n erstand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
.lnderstand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
)assing inspection during any six month period during the renewal period.
Justification 6co -k "OVA -i : , ` � n o �NEL)
f�M
WNER/BLDR OR CONTRACTOR SIGNATURE
W� VIM
Print Name
-,2-3 r 19
DATE
,TATE OF FLORIDA
OUNTY OF . L ur.'\ �
CKNOWLEDGED BEFORE ME THIS 1L DAY OF Y11" 120 11
Y \+►�\\ �� �0 P i2 h S WHO IS PERSONALLY KNOWN TO ME OR
S PROVIDED L 1pL AS IDENTIFICATION.
I _ _
I SFATE OF FLORIDA, County of
=o;•••••. CIEANNAMARIEGIVENS !!�
MY COMMISSION # GG 022023
S GNATURE OF NOTARY .F P EXPIy�p�Member 16,21020
• Bonded Thru Notary Public Uiden✓ntei
OFFICE USE ONLY:
ier of Open Inspections:
Inspections:
le open by total to get % of open inspections)
permit fee: x % open = $ Renewal fee
[15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
7/21/2014
19', ro, ap'f