HomeMy WebLinkAboutPERMIT RENEWAL REQUESTMay 24 2017 0729AM I Crompton _ Electric, Inc 5615859088 pFs P 1
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
9 �> BUILDING AND CODE REGULATIONS DIVISION
' w• 42300 VIRGINIAAVE
FORT PIERCE, FL 34982
(772) 462-1553 , Fac (7J2) 462-1578
5(:HNNED
PERMIT RENEWAL REQUEST St. lUC6 COUI)tV
PERMIT NUMBER: 1SIZ"OZyY ADDRESS: 101cop_1S CePan4k.,, IliTf-444-Art 9V!FP,
-0
I, : ( A i ate , 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.
Justification .�x,r -Ea
AVL`DRCTOR SIGNATURE — �I TE
1v1ilJ{or_I air'te-
Print Name
STATE OF FLIDA
COUNTYOF gam.
ACKNOWLEDGED BEFORE ME THIS,j_f�AY OF 2p
BY M�r.�a,�-�� WHO IS PERSONALLY KNOWN TO ME J , OR
HAS PROVIDED
AS IDENTIFICATION.
0 WATURE
ORIDA, Co 01471R.'1'Sl �e�l.
,�CLAUDETTE MARIE RAMOSOF NOT s =.: _• ComMssiar 8 FF 123283
Expires May 14, 20%
Bstltl Tm Dq FlE�Wm Mli
FOR OFFICE USE ONLY: — — —---- ——--
Number of Open Insp ons:
Total Inspections: Lf
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee ^
Example: [15 divided by 23=.65("6)] $ l75(permit fee) x .65=$ l 13.75 (renewal fee)
Revised Tal/2014
r2pot�
t