HomeMy WebLinkAboutProject Information 11/09/2016 09:46 FAX 2001/002
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Q , 4 BUILDING AND CODE REGULATIONS DIVISION
.- 23001'IRGI\IA AVE
FORT PIERCE,FL,34982
(7 72)462-1553 Fax(772)462-1578
RECEI'.'TD NOV 0 92016
PERMIT RENEWAL REQUEST
PERN41T NUMBER: SLC 1604-0027 ADDRESS: 12623 S Indian River Dr-Jensen Beach, FL 34957
I Robert. W. Ludlum ant requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be Iinaled. 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,
1Ustification is presented for a renewal due to our client's extensive travel away from the area, loss of the priority
mail package confirmed,deJiv&ed, and/or, not having access to permit documents sent through electronic mail.
f:
. :
r
_ �`.f:�=s:,-,>o���.,s:-"•...__�_..___.__.__... November 9, 2016
'OWNERf13LDR OR CONTRACTOR SIGNATURE•' DATE
Robert W. Ludlum
Print Name
STATE OF FLORIDA
COLTNTl'Ol: sainl Lu Lia
ACKNOWLEDGED BEFORE.ME THIS 9 DAYOF November ,)016
RY Robert. W. Ludlum WHO IS PERSONALLY KNOWN TO I\rIE OR
HAS PROVIDEDASIDENTIFICATION,
_..._ :SPRY^�a LESLI D ZELAYA
'
STATE OF FLORIDA,Counh Saint Lueie of -' MY COMMISSION#FF165172
Yr,
Or oP: EXPIRES October 1,2018
(407)398.0153 Florida NotaryService.com
STGNATU,RE fOF NOTARY ` tihA1,
;y,'•
-----
FOR OFFICE USE OI,N,r.L.Y:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get 90 of open inspections)
Percentaae:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.6i(%A $175(pennit fee)x.65=$1 13.75 (renewal fee)
Revised 7/21/201.1