HomeMy WebLinkAboutUntitled PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
•
_ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
1
PERMIT RENEWAL REQUEST
PERMIT NUMBER: l b (� ��J I ADDRESS: O�o S 0 C,& r PY2, �L� 0
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
C Zc I
OE LDR OR CONTRACTOR SIGNATURE DATE
Print Name
1
STATE OF FLORMA
COUNTY OF )7A--LAG�—P, _
ACKNOWLEDG D BEFOR ME THIS c_ �AY OF 20
r^
BY V(�► ` G�M E NALLY KNOWN ME OR
HAS PROVIDED AS IDENTIFICATION.
r
STATE OF FLORIDA,County of
T RE brARY SEAL
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FOR OFFICE USE ONLY:
Number of Open Inspections:
ANGELA M`UFF
Total Inspections:
Notary Public-State of Florida ,.
(Divide open by total to get%of open inspections) ° •5 Commission#FF 234730
Percentage: =kr ' tPo; My Comm.Expires May 27,2019
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n."
Original permit fee: x%open = $ Renewalfee`r«�i<���``� Bonded through National Notary Ass
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014