HomeMy WebLinkAboutMisc Letters MAR/30/2016/WED 03;04 PM FAX No. P. 001
I�i�IMMM PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVIE
FORT PIERCE,FL 34982
(772)462-1553 Bas(772)462-1578
PERMIT RENEWAL REQUEST
PERMU NUNMER: 1507-0166 ADDRESS: 2005 N.44th St, Fort Pierce, FL
Matthew McClellan ,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. Finther, l
understand that this is a ONE TEME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification �nssi�c �sfRh,� �
3/30/16
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Matthew McClellan
Print Name
STATE OF FLORIDA
COUNTY OF saint Luce
ACKNOWLEDGED BEFORE ME TEAS March DAY OF 30 12016
BY Samuel Cabrera WHO IS PERSONALLY KNOWN TO NE ,OR
HAS PROVIDED License AS IDENTIFICATION.
STA FL co„otyafSaint Lucie
Notary Pubfia stats of Mrlda
SIGNA Samuel Cabrera
My offmisslon FF 011)52a
7p' fres 08/19/201a
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections-
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014 RECEIVED
MAR 3 0 2016