HomeMy WebLinkAboutPERMIT RENEWAL REQUEST-.9 � V� W -00g9
--- —MEMEN PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
J i
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RECEIV — FORT PIERCE, FL 34992 ED
(772)462-1553 Fax (772)462-1578
S+c� SEP 13 2019
PERMIT RENEWAL REQUES* a aCounty, oun
tY, Pefrhittfng
CoU�
PERMIT NUMBER: ADDRESS: 72 Ir .Dr_
IL ,V ; , am requesting that the above permit be renewed. I
understand tha must schedule pass all required inspections for the permit to be f'tnaled. Further, I
understand that this is a HE
TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six moot I period during the renewal period.
Justification��.}- �—Rkyf
OWNER/BLDRQLLCO ;kXACTORSIONATURE DATE
Print Name
STATE OFFLO�ipA
COUNTY OF �`�eE�C—
ACCKNOWW_LEDGErD BE(F� REI`IMETFBSy.� DAYOF
BY ��' �" t1C11+�,G5 ^' _WHO I RsONAL P"� .OR
HAS PROVIDED
AS IDENTIFICATION.
p :: X% TMOMAS W. STEUENS
sIGNATU ARY SEAL; ' COrtrn4ab0flFF809TT!
tt; ,"- � Explies Octaber8 2D18
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x %open = 5 Aenewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
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