HomeMy WebLinkAboutPermit Renewals r ,
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT-PIERCE,FL 34982
(772)462-1553 Fax(772);462-1578,
PERMIT RENEWAL(REQUEST
PERMIT NUMBER: I lO0(y-Ola-5 ADDRESS: a'o7 N- 3gTN P;erCe,F L
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I, Boysie Ramdial ,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 There �� M a-� off° d ki c lk
per ryi� Lo L i n s i
OWNERIBLDR.OR CONTRACTOR SIGNATURE DATE
Boysie Ramdial
Print Name
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STATE OF FLORIDA t,I
COUNTY OF LX(Y 1
ACKNOWLEDGED BEFORE ME THIS 3 DAY OF t�_V�6' Zo G
BY d cd WHO IS PERSONALLY KNOWN TO ME��OR
HAS PRO ED AS IDENTIFICATION.
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STATE O F ORID o my of �r01k'�' Amber Flenlcer
NOTARY PUSUC
-+STATE OF FLORIDA
SIGNATURE OF NOTARY SEAL Comm#FF970934
Expires 7/1112020
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections) I'
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014
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