HomeMy WebLinkAboutPERMIT RENEWAL REQUEST03/28/2018 12:58 FAX 7724606929
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PLANNING AND DEVELOPMENT SFRWCFS DEPARTMENT
PERMIT NUMBER: 1709-0005
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINL4 AVE
FORT PIERCE, FL 34982
(772)4C-1553 Fax(772)462-14578
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PERMIT RENEWAL REQUEST
ADDRESS: 106001 S OCEAN COMMON AREA
ROBERT WILLIAMS = requesting that the above permit be renewed. I
�derstand that �Imust �schedule and �pass all �required inspections for the permit to be finaied. Further, I
understand that this is a 0 NEWAL and the permit shall expire should I not receive a
passing inspection during gy M-Wh period during the renewal period.
Justification JOB WAS POSTPONED DUE TO HURRICANE IRMA IN 2017.
trL.000-- 3-28-2018
OWNERIBLDR OR CONTRACTOR SIGNATURE DATE
ROBERT WILLIAMS
Print Name
STATE OF FLOPJDAS+
COUNTY Of.
ACKNOWLEDGED BEFORE ME TRIS _a DAY OF 20-L-
BY WHO IS PERSONALLY KNOWN TOME_ OR
HAS PROVIDED AS IDENTIFICATION.
STATBOFFLORIDA, ounty0f UULL
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SIGNATURE OFNOTA-Ry U SEAL IT.2021
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Number of Open Inspections:
Total inspections:
(Divide open by total to Z�t % of open inspections)
Percentogge:
Original permit fee: _ x % open = S _____.Renewal fee
Example: (15 divided by 23=,65(%)) S175(pernalt fee) x.65=SI13,75 (renewal fee)
Revised 712112014