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
PERMIT RENEWAL REQUEST
RECEP D 0.25. 2012 -- - - - - - - - _ - - - - -
PERMIT NUMBER: I YLV��yADDRESS:
I, ?(�S0�1 ,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 � '
OWNS LDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF SSC
ACKNOWLEDGED BEFORE ME THIS�5 DAY OF Ck •1N 26
BY a.SOrl\ S'r Ca,-0 S'01 WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
TATE OF FLORIDA,County of '�'a�-V G\�
MARIE GIVENS
' MY COMMISSION#GG 022023
SIGNATURE OF NOT ARES:December 16,2020
''•F� °p' Bonded Thru 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 7/21/2014