HomeMy WebLinkAboutPERMIT RENEWAL REQUESTa-iANNING AND DEVELOPMENT SE&rCES DEPARTMENT
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`d k BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST eQanme�`
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PERMIT NUMBER: 1904-0572 ADDRESS: 1272 Nettles Blvd, Jensen beach, FL
1, Steven Drake Marston Jr , am requesting that the above permit be renewed. I
understand that I must schedule 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. SCANNED
Justification I did not realize I needed a ladder for a 1 story re -roof. I will have it set up. BY
Lucie County
OWNERBLDR OR CONTRACTOR SIGNATURE
jriintia�me
-
DATE
STATE OF FLO
COUNTY OF -1
ACKNOWLEDGED 1�BEFyOR 1E/MDE THIS
y2�_DAY OFF �1 J11 l�1 1 \l A-1 , 200
BY �VU I � QyE 1 1 l 1! �b J IS PERSONALLY KNOWN TO ME V OR
HAS PROVIDED
STATE OF FLORIDA, County of C -H UF,(?
n)h M YloH-�
SSMNI ,TURF OF NOTARY
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 = $ Renewal fee
AS IDENTIFICATION.
CYNTHIAM.NUTT
WCOMMISSIONNGG1T7913
S o EXPIRES: Juwaiy 22, 2022
"a EAV eo�amNNorvyPwrcwaawfltvs
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 721/2014