HomeMy WebLinkAboutPermit RenewalsPLANNING 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
PERMIT NUMBER: `�y� 7s ADDRESS:z-74 1 Vu—[+ I QS Olvcl
I, 1h C hcwCA ['e—q i n --ZO n , 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 inspect' n ' g any six month period duri the renew/al peri d.
Justificat},on dur��% was �12 Ld rn le-je,
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O D'R!, R CONTRACTOR SIGNATURE ATE
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Print Name
STATE OF FLORW„, /
COUNTY OF Y Y j�
ACKNOWLEDGED BEFORE ME THIS ��DAY OF I' Io 20
BY R( � a � r',n� ,SPAT a�� T'' 84
l�� WHO IS PERSONALLY KNOWN TO ME ,�. MY C08ADMJDN
HAS PROVIDED AS IDENTI EXPIRESJOun 1.0
ow
4IGNA
OF FL A County ofni'
PATTIE JO NETTLES
MY doMMISSION FF95”
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FOR OFFICE OFFICE USE ONLY:
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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