HomeMy WebLinkAboutPermit RenewalsPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS' DIVISION
Mel -4 1 k 2300 VIRGINIA -AVE
FORT PIERCE.
FL 344k
(772) 462-1553 Fax (77.2) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ADDRESS:
Peter A Cafaro III
,.am requesting that. the above'permit be renewed. I
understand that I must schedule and pass all required-inspettions for, the permit to be finaled. Further,
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. --4
Justification
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OWNELDRORCON 'fRAC \O SIGNATURE DATE
Peter Cafaro III
Print Na e
R-11
STATE OF FLORIDA
COUNTY. OF - ORANGE
ACKNOWLEDGED 13EFORE ME THIS DAY OF 20
BY Peter A Cafaro III WHO -IS. -PERSONALLY KNOWN TO -T ME,' OR
HAS PROVIDED AS''16:ENTIFICATION-'_
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get i/. of open inspections)
Percentage:
Original permit fee: x %open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x.65=$113.75
Revised 7/21/2014
-enewa. I fee)