HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• 2304 VIRGINIA AVE
` FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: C 07 Qq-o 1 ADDRESS:
i, M lG E4*0'Q�Cwle ,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 "to Pry1—I!Vb ON �l ry4
W4_ �m L-"oL^'ty tS N i
(OWKh7RK6DR OR CONT CTOR SIGNATURE DATE
Goo 04n�I r*�
Print Name
STATE OF FLORIDA [
COUNTY OF s - �J
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 t
By t� DNA�LLYKNO06DW�TME OR
HAS PROVIDED AS IDENTIFICATION.
TE OF FLORIDA, ounty of a� C' 1AUFF
Notary Public-State of Florida
?_,* � ,- Commission#FF 23g732019
SIGNATURE 0 OTARY _ MY Comm.Expires may 27 Assn.
Banded through National 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
Example: (15 divided by 23=.65(%)] $175(permit fee)x.65=$t 13.75(renewal fee)
Revised 7/21/2014