HomeMy WebLinkAboutMisc Letters PLANNING AND>DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• 1300 VIRGD A AVE
FORT PIERCE,FL 34982
(772)462-1553. Fax:(772)462-1578
PERNIIT RENEWAL:REQUEST
PERMU NUM BER: O J am.® . ADDRESS: Pot,
I, — e-odere Mann ,:am is uestin thatthe.eQ g permit be_renewed. Y
understand that I must schedule and pass al1 requjred inspections.for the permit to be&aled. Further,I;
understand that.-this is:a ONE TIME RENEWAL and the permit':shall expire should L not receive a
passing inspection during any six;month period during th6renewal:period.
Justification Snor a' S ( p4? �l' c t dD (Q5(' ii c
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OWNERMLDR OR:CONTRACTOR SIGNATURE DAM
`sl2eQdOne a
PantName
STATE OFFLORIDA.
COUNTY OF
ACKNOWLEDGED BEFORE?M THIS.. ( L ' DAY OF � L ,20 I LV
BY`
"Ore . 0 n - WHO IS PERSONALLY KNOWN TO ME_-_✓ ,OR
HAS PROVIDED AS]DENTIFICATION_
5 TE OF FLORIDA,.County of,
DEBORAH RUSSELL
Notary Public-State of Flonda :
SIGNATURE OF:NOTARY =°, a Comm.Expires Nov 30,2013"
r M Commission #FF 179630
Bonded through National Notary Assn.{'
FOR OFFICE USE ONLY:
Number of Open Inspections:
TotalInspecti ons:
.
(Divide open by.total to get%of open.inspections)
Percentage:
Original permit fee x'%open = $ Renewal fee
Example: 115 divided by 33=:65(%0)] $1T5(permit fee):x.65=$113.73(renewal.:feej;.
Revised 721Ro14
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