HomeMy WebLinkAboutPermit Renewals -- PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
i
MUM= Building and Code Regulations Division
----- — 2300 VIRGINIA AVE.
FORT PIERCE,FL 34982
(772)462-1553
PERMIT RENEWAL REQUEST
*71Z
ADDRESS: IDG 6 U S O C uA-N DddF, PERMIT NUMBER:
I, k t c. &&DOW,j ,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 eriod.
Justification ►�—i--
c �
WNER/BLD OR CONtIVACTOR SIGNATURE DATE
Print Name
STATE OF FLOID ��� e�
COUNTY OF JJ
ACKNOWLEDGED BEFORE ME THIS�_DAY OF ,20L-11
BY 1 -V \ V' ` S RSONALLY KNOWN T ME ,OR
HAS PROVIDED AS IDENTIFICATION.
f
STATE OF FLORIDA,County of
OkAVNIA A
IV `
SIGNATURE OF OTARY
`y otpRYAVg"" ANGELA M �
FOR OFFICE USE ONLY: cd= m p`�: HUFF
4 Notary Public-
-. •'= Co State of Florida
�. -: .o,, Commission#FF 234730
Number of Open Inspections: of F;� `My Comm,Expires May 27 20»
Total Inspections: Bonded thro h National NotaryAssn.
rz,
(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=$113.75(renewal fee)
Revised 6/24/2014