HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
a BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: " ADDRESS: ` _ & d)OA C �--
I, 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 (.I\-Q-0 C1 -; C D() ice,
OWNER/B R OR CONTRACTOR GNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF S"� •x-11 c�e-
ACKNOWLEDGED BEFORE ME THIS 0 DAY OF Q A C•�� .20n_
BY q 3O�i� S t S'C WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED <- ID L AS IDENTIFICATION..
STATE OF FLORIDA,County of 5 �• l.•�fi-�"�+ _--- —�"`
DEANNAMARM ODIEN'S
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�• MY COMMISSION#GG U?202
7SIGNATURE OF N ARY ;: eXDecember 16,�2mers
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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 W2I/2014