HomeMy WebLinkAboutPIONEER RENEWALPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY
F L O R 1 D A
PERMIT NUMBER: 1510-0363
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 9500 S. OCEAN
I MICHAEL EWING , 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 WAS PLACED IN A COMPLETED FILE BY ACCIDENT.
WNERBLDR R ONTRTTOR SIGNATURE OATE
MICHAEL EWING
Print Name
STATE OF FLORIDA
COUNTY OF �5+. Ll1&e-
ACKNOWLE,D, GEED BEFORE ME THIS,2 OF B 20�
BY 02 \ L►) ae� eL._-�1 nQ WHO IS PERSONALLY KNOWN TO ME �, OR
HAS PROVIDED
TA FLCounty of f. At U t'=
SIGNATURE OF NOTARY
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
AS IDENTIFICATION.
.0ay pw., DEBORAH RUSSELL
Notary Public - State of Florida
?„y Commission # FF 179630
My Comm. Expires Nov 30, 2018
Example: [15 divided by 23=.65(%)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 7/21/2014