HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2304 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: �> 0 D�D ADDRESS: i 00C.)0
t ry am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be Analed. 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 M �-✓�-��% �, �,�,,,, yr, -y
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OWNERBLDR OR CONTRACTOR SIGNATURE DATE
L
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS_ _t1�DAY OF 201-
BYi & ��Y W,n !—WHO IS PERSONALLY
KNOWN TO ME ,OR
HAS PROVIDED � a ' ' ' AS IDENTIFICATION.
E OF FLORIDA,Colm ty of „ LASHAHNA INGRAM
Notary Public-State of Florida
IJ Comm.Expires Dec 20.2018
GN TUBE OF NOTARY r 't y Commission 4 FF 177249
S �cj, ar° Assn
Bonded thsouagatio otar
"' --------- __________________
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
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