HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
_......m_ .. FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
R E C E I V ! ��' w ``- ':�� PERMIT RENEWAL REQUEST
PERMIT NUMBER: ADDRESS: \o �3 us kiW l � L d+ cq
i,l jIyOKe SS l 0. f_ L C ,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 \ // 'l2e
Y-A T�� v se• n.-� ��...�,
O R/BLD N TOR SIGNATURE D fE
Prkrt ame
STATE OF FLOF.JDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _DAY OF �q+r� 20U_
BY Ro vN o v\- T\`i V`N a"n WHO IS PERSONALLY KNOWN TO ME OR
T
HAS PROVIDED t-- -0 L� AS IDENTIFICATION.
STATE OF FLORIDA,County of S� OC Q
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'-�'�� �- "I"'• D�N+4MARIEGNENS
SIGNATURE OF NO Y *c ;4e WVOMMISSION#GG 021023
c EXPIRES:December 16.2020
''F0 ���'•• Bonded Thru Notary Publ(c 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 7/21/2014