HomeMy WebLinkAboutUntitled PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMITNUMBER: 1601 —V(ot l ADDRESS: –1G1
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I, M'C'(tft-L- iN ,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 t w
7
OW ER/B R OR C/O R CTOR SIGNATURE! DATE
Print Name
STATE OF FLORID D
COUNTY OF �
ACKNOWLEDGED BEFORE ME THISo DAY OF 120_[_
p.
BY /(COIL ,`Pi' ���I30 I SONALLY KN O O ME ,OR
HAS PROVIDED AS IDENTIFICATION.
S TE OF FLORIDA,County of
t, `.• �, t°^� NOParmmission NG LA M HUFF
Ar, £ R y Public-State of Florida
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A E NOTA Y "E X:
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Comm.Expires May 27,2019
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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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