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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: ! d© 2 O -Ll b ADDRESS: SSW 12- ©19 .3.5 /-'-/ -S 7- S3 w• ,T1-1 , am requesting that the above permit be renewed. I understand that I must schedule and pass all required inspections for the perrnitito 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 ca� T (4-�L qam R $,I— LO-? I�-� C' ,�► n� � )-lJ�b OWN R/BLDR OR eONTRACTOR SIGNATURE IIATE (rpt Print Name STATE OF FLORIDA COUNTY OF �/ ACKNOWLEDGED BEFORE ME TFHS DAY OF 20 By \` C�.a,"�!S PERSONALL�KNO ME , OR HAS PROVIDED AS IDENTIFICATION. 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(0/o)] $175(permit fee) x.65=$113.75 (renewal fee) Revised 7/21/2014 ANGELA M HUFF Notary Public - State of Florida Commission # FF 234730 My Comm. Expires May 27, 2019 Bonded through National Notary Assn.