HomeMy WebLinkAboutPermit Renewals i
PLANNING 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
PIT NUMBER: �O q ADDRESS:
I, ET ,am requesting that the above permit be-renewed. I
un erstan that I ust c edule 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 si month period during tl renewal period.
Justification e
t
R/BLDt OR CONTkA1ct6R SIGNATURE D E
S lv
PrlhtNaime
STATE OF FLO
COUNTY OF
ACKNOWLEDGED BEFORE METHIS 11 DAY OF 201_
BY � �'{�`I y - WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE 0 FLORICoun f cd )A )O,Tl
A, �
ME-M]
. NIELSENSIG A O OTARY # FF 115637sion Expires2. 201 S
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections) y�
Percentage: 1 b
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