HomeMy WebLinkAboutMisc Letters JUL-11-2016 16:59 From:DENTISTS OF STUART To:17724621578 Page:1/1
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,PLANNING AND DEVFLOPMMNI'SERVICES DEPARTMENT
BUMDING AND CODE REGULATIONS DIVISION
2300 VIRGPW AVE
FORT PIERCE,n 34982
(772)462-1553 P2$(772)462-1578
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PERMIT RENEWAL REQUEST
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ADD 2ESS- } LL)
FBIt1V7ZT NUMER
i, t L, 'n Q- am requesting that the above permit be rene�ued. 7
undexstaand that I trust schedule-mass all required inspections for the permit to be finaled, Further,I
un&"stand that this is a ONE TIME RENEWAL and the permit skull expire should I not receive a
passing inspection during any sir month period during the renewal period.
Justification
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LDRd CO GTOR A AIE
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PriatName
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STATz OF FLORMA -
COUNTY TY OF_ t�'-}�t..a L t e-
ACKP OWLWMD)BEFORE W TITS. DAY OF ,S VN .20 1 I�
BY _!jU1t2 �. �2.c{'2i r WHOISPER54NALLYI4N 110 t TO _ ,OR,
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HAS TROVIDED AS IDE T MICATION.
STA1I?OF FLORU)A,Cov:iry of c,e Imay Fasft-swe o1 Fowift
0\-• A"Vo-rte.... My temm,Es*es Oct W2019
StUNATU1t2EOFNOTARY SEAL, ' ca mlizzlon#ff 13m0
1t�t1llf1on�11 d"OS n.
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CDR�pmcm un OAR.Y:
Number of Open Inspections:
Total Inspections:
(Divide open by totd to net%of open inspections)
Pere tage:
Original permit fee x%opera - $ Renewal fee
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Example: 115 divided by 23=.65(%)i $I7S(perWt fee)x.65--$1 I3.7S(renewal fee)
Revised 7/22/2014
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