HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FI,34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 51-C MOV- 7 ADDRESS: f5:2-7 /andel waoot �r
I, �A4;,.)Ie- ,0- / oaff"S ,am requesting that the above permit be renewed. I
understand that I mu 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 y�p6f e��l r �� rro7frc2 E.�rI'a7� 0"t Cf�e�
O R/BLDR OR CONTRACTOR SIGNATURE DATE
RaLerr 01 k4eis
Print Name
STATE OF FLORIDA
COUNTY OF —4,�
ACKNOWLEDGED BEFORE ME THIS SDAY OF 201
BY 1,0bltl'� `RO q%'z 5 WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED VL" Q L-- AS IDENTIFICATION.
STATE OF FLORIDA;County of 5 L V C
; .j,PV PV DEANNA MARIE GIVENS
* ;*; MY COMMISSION#GG 022023
SIGNATURE�OFN Y :� EXPIRf6pember 1S,2020
Bonded ThNotary Pubilc Undenrmters
---------------------------- ----------------------------------------------------------------------------------------------------------------------------
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