HomeMy WebLinkAboutpermit extention _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300VIRGINIAAVE
- — FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
1
PERMIT NUMBER: SLC-1506-0013 ADDRESS: 8111 Indian River Dr.
I, Boysie Ramdial ,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 TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification The permit expired due to the homeowner being out of town and having to
re-order the products the permit expired. The installation is close to finish and needs a final inspection.
06/28/16
OWOW EN�R/BLDR OR CONTRACTOR SIGNATURE DATE
Boysie Ramdial
Print Name
STATE OF FLORIDA
COUNTY OF Lake
ACKNOWLEDGED BEFORE ME THIS 28 DAY OF.June 2016
BY Boysie Ramdial WHO IS PERSONALLY KNOWN TO ME X OR
HAS PROVIDED AS IDENTIFICATION.
Amber Fie jw
STAT FL A ounty of Lake NOTAA STAT� BA
CW04 FF97004
a Expires 7/11=0
SIGNATURE OF NOTARY SEAL
-----------------------------.--------------------------------------------------------.------------....--------------------------------------.--------
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) n
Revised 7/21/2014 4�
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