HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
�} 2300 VIRGINIA AVE
FORT PIERCE,FL 34982 ��yy
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST << sF�
PERMIT NUMBER: ,� d a�LS ADDRESS:
I, G'v�s-fie- ,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, l
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
s
OWWNNER/BLDR OR CONTRACTOR SIGNATURE DA E
Print Name
STATE OF FLORIDA
COUNTY OF
c�t
ACKNOWLEDGED BEFORE ME THIS o2 / DAY OF�� �-��. 20 / 7
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA Countyof .Gv
Q
DIANA ROVIRA-HERNANOEZ
MYCOMMION#GGEXPIRES:JUN 12,202onded throuth 18
t State Insurance
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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