HomeMy WebLinkAboutPermit Renewals r4y PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
- 2340 VIRGINIA,AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
RE E) '0 SES' 2 PERMIT RENEWAL REQUEST
PERMIT NUMBER: l� !�" d 0$�d ADDRESS: --7 O q 4I r 61 cSC'1M
I,_I CA rnift WCJf'^S 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
O LDR OR/CONTRACTOR SIGNATURE ��DAYEI-�
j ami s_. j �
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS a8 DAY OF A 20_)3_
BY :5 u 4V\k�S WHO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED 'T-L 1 AS IDENTIFICATION.
STATE OF FLORIDA,County of `~+' )C L�}e
ENS
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SIGNATURE OF NOT ` ,,` �� "h: 1QMtAlS e!o m�yrG6,2020
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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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