HomeMy WebLinkAboutMisc Letters APR/26/20'16/TUE 10:42 AM FAX No, P, 001
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PLANNING AND DEVELOPWNT SERVICES DEPARTWNT
BUILDING AND CODE REGULATIONS DMSION
2300 VIRGE4JA AVE
FORT PIERCE,IFI.34962
(772)462-1553 Fax(772)462-1578
PEMIT RENEWAL REQUEST
P IRMIT NUMBER:�50-7- 016-7 ADDRESS: 2ZQ9 E.�WA2 !moi
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I, Aa,-46y MCr-,1 oafl ,am requesting that the above permit be renewed. I
understthat I must schedule and pass all required inspections for the permit to be finaled. Further,I
understand that this is a ONE TIlUE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six mouth period during the renewal period.
Justification t--MP1-00E JN CFf►9�G P M'1 t �U � (
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FI, t" A
COUNCY OF f
ACKNOWLEDGED BEFORE ME TMS ZG ))AY OF A 20�
BY Int h7rgt10 WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIpkD ��!U�'� i_l GEnJS� AS IDENTIFICATION.
STATEI OF FLORIDA,County of P � Public State of Fbrrda
Sartmel Cabrera
SIGNA, SEAL My C.ommrsslon FF 910529
V,N Expires 0p118/2019
FOR OFFICE US1u ONLY:
Number of Open Inspections:
Total Inspections:
(Dividei 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
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