HomeMy WebLinkAboutUntitled PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- ry BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMITNUMBER: (p[�j DO�?j ADDRESS: 100OLf 4 S 0 C4,—, 1}L,,A I✓rz- lOV
am requesting that the above permit be renewed. I
understand that I must schedule anO 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 �
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OW R OR CONT DATE
Print Name
_ STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 P7
BY �,1; },C�A ALLY KNOWN TO ME OR
HAS PROVIDED / AS IDENTIFICATION.
TE OF FLORI L,County of �
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GNAfUjA FNUTA Y SEAL
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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 7/21/2014
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