HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 V 1RGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
SCANNED
BY
St. Lucie County
PERMrr NMBER: 1503-0090
PERMIT RENEWAL REQUEST
ADDRESS: FL Turnpike Service Plaza -Mile Marker 144
4 Richard Banten 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 mon period during the renewal period.
Justification Due to complications on -site, the installation has been delayed.
9/14/2015
DATE
Richard Banten
Print Name
STATE OF FLORIDA
COUNTYOF Hillsborough
ACKNOWLEDGED BEFORE ME THIS 14th DAYOF September 2e14
BY Richard Banten WHO IS PERSONALLY KNOWN TOME XXXX OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF DA, tyof Hillsborough wiry NANCY IVETTE RUPERTO
k
MY. COMMISSION 9 FF241211
SIGNATUIRE11OF NOTAftY SEAL 'a!/r., EXPIRES June 17.2019
FOR OFFICE USE ONLY:
Number of Open Inspections: _
TotalImpeetions:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x %open = S Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65-S113.75 (renewal fee)
Reviled112141014 RECEIVE
OCT 15 2015
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