HomeMy WebLinkAboutPERMIT RENEWAL REQUEST01/17/2008 02:37 77246F9"'1 RRSHEETMETALWORK_SINC PAGE 11 /03
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE SCANNtU FORT PIERCE, FL 34982
(772) 462-1553 Fox (772) 467--1578 BY
LUCIp
PERMIT RENEWAL REQUEST
PERMIT NUMBER: _ 9� ADDRESS: NO r ST • 33 `z--r� .�'r? C��'
I, 4I11 '�i {`d D, l i I t. I I CtMS ain requesting that the above permit be renewed. I
understand that I must schedule and pass all required Inspections for the permit to be 9naled_ Further, l
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.
9wNEFjBLDR OR CONTIrACTOR SIGNATURE
d�. �t ',l D . IU'l l i iajj c
Print Name
DATE
STATE OT FLORID Q.
COU. ITY OFara_
ACKNOWLEDGSDBEFORFME THIS OW bAY OF y LL Zp�
RY�II� ild - [, UI I IC]/ Q WHO IS P6RSONALLYKNOWNTOWE i/ .OR
HAS PROVIDED
STAT F FLORIDA, Couatyof
SIC NATUTO FNOTARY
FOR OFFICE USE ONLY:
AS IDENTIFICATION.
RAOUEL MDNMvjAvt�.
`° Notaty Pu01N • SuCommisol" 0 OSF.A �BanaeN Fily hrough Nm. lres Mu 2021
2llOaL
Number of Open inspecions: e D O
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage.
Original permit fce: x %open = $ �Renewal fee
Example: [15 diNided by 23^ 65(%)] S175(perntit fee) x .65=5113,75 (renewal tee)
Rnis°d 7/2112014
ZEN I - I I M—W