HomeMy WebLinkAboutMisc Letters Mar 1516 01:11 p AMERICAN PB GARAGE DOOR 772-41,191-10576 P.1
PLANNING AND DEVELOPMENT SERVICES*DEPARTMENT
BUILDING AND CODE REGULA17IONS DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE,FI,34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 0-1 — 0 17J ADDRESS: 2-50C) 0o11 y be rr-q Lki.
L 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 TEWE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification ow" rs. [7t-{Lk OC 4k-5,-
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WNERIB11DR,OR CIIN SIGNATURE DATE
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Print Name
STATE OF FLORIDA
COUNTY OF MAV--V%r-N
-LEDGED BEFORE uE THIS 20
ACKNOW DAY OF
BY T7 —
rC- 'b Y16-fe r 0 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDONUIFICATION.
ST OF OM4k, NOWY Puft State of Ffo*a
Uah Joslin
9V
W CaMmMon FF I90505
SEPOW 12mamis
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections.
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x VD open = $ Renewal fee
Example: [15 divided by 23=.65(%)l S175(permit fee)x.65=$113.75(renewal fee)
Revised 7121 f2014