HomeMy WebLinkAboutProject Information PLANNING:AND DEVELOPMENT'SERVICESDEPARTMENT
BUELDIN.G AND.CODE REGULATIONS.D"ION`
2300.VIRGINYA AVE
FORT PIERCE;FL 344$2
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(772)462-1553. Far(772)462-157.8
PERMU-RENEWAL REQUEST
RECEP''�D SEP 0
PERMrr NUMBER: 1609 i�3 .�. .. ADDRESS: t7La r IAQ01 Vot
I, -ie,0A a'P Im q r,n _ ,am requesting that the:above permit be renewed. I'
f understand that I must schedule,and pass all required inspections for the permit to be finaled: Further;I.
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understand that this is a ONE TIMERENEWAL and the permit:shaU expire should I not receive a
passing inspection during any s :month period.durng the;renewal:period:
Justification 5njof,,7r
OWNERBLDR OR;CONTRACTOR.SIGNATURE. A
P1 pd'orP Mann
Print-Name
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_STATE OF FLORID
COUNTY OF
i. ACKNOWLEDGED BEFORE ME THIS_�DAY OF. 1+71 b& .20/ U.P
BX`� �QGQ O rf (Y1417 n. V1►H01S PERSONALLY KNOWN TO AS' ✓ ..OR
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HAS PROVIDEID. . AS.IDENTIFICATION.
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5 TE OF FLORIDA,County of.. Lu -e— OEOORAM RUSSELL
Notary Public-Stab of630
HygJLfLC. ; Commission N Pf 179630
SIGNATURE.IOF NOTARY My Comm.Expires Nov Florida30.2015
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FOR OFFICE USE ONLY: pp
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Number o€Ogen Inspections:
Total,Inspections: .
(Divide open by total to get"70 of open inspections) aJ
Percentage:
.' Original permit fee. x%open = Renewal fee;
Example [15 divided by 23=.65(%)] $175(0ermit fee)x.65=$113.75.(renewal.:fee):
Revised 7/`212014
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