HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
UITM Building and Code Regulations Division
2300 VIRGINIA AVE.
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
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PERMIT NUMBER: kCoa1"0 5C� ADDRESS:J U �`�` c u ff,17 �CP4� y✓ice
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I, %A pS�(eC� &6_f"49 ,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 sixm nth period during the renewal period.
Justification 'I'-
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R/ LDR OR CONTRACTOR SIGNATURE DATE
J a •eF`
Print Name
STATE OF FL9IDA J c`�
COUNTY OFbb
ACKNOWLEDGED BEFORE ME THIS_�DAY OF ,20_n_
BY �-d)D% V'T�_ WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED L �— AS IDENTIFICATION.
STATE OF FLORIDA,County of
\ ""••. DEANNA MARIE GIVENS
SIGNATURE OF N ARY = MMISSION#GG 022023
EXPIRES:December 16 2020
?oF Bonded Ttw Notary Public Underwriters
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=$113.75(renewal fee)
Revised 6/24/2014