HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• ► 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553- Fax(772)462-1578
PERAUT RENEWAL REQUEST
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PERMIT NUMBtER: SU k(o09-Orj 3�n ADDRESS: L15U 5 {�!1 ry1p. (.t,N� Qe dam'
i, 14IC c *w_Tie&rcam requesting that the above permit be renewed. I
understand that I must schedtfle 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 durin the renewal period.
Justification AEEb Jb 'ave— Nu- r p, a r,_ u.4 COt',.[fR4 d-
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OWNEIRJBLDR OR CONTRACTOR SIGNATURE DATE
A.knt.tel 1. l�lt►'�l�l,f'Vl
Print Name
STATE OF FLORIDA
COUNTY OF t�J
ACKNOWLEDGED BEFORE ME THIS� DAY OF &J i I ,201
BY � ye4 T. -J Urka.&i WHO IS PERSONALLY KNOWN TO ME ✓ ,OR
HAS PROVIDED AS IDENTIFIQ
STATE OF FLORID Countyof �r uc;P ��� ";t..�...SIO�F°
GNATURE OF NOTAW SEA1a*; N• ."
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FOR OFFICE USE ONLY: �ii����otji �ti
Number of Open Inspections:
Total Inspections: ' '
(Divide opecrby total to get%of open inspections)
Percentage:
Original permit fees x%open = $ Renewal fee ••
Example: J15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014