HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
0
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: + F 0�S ADDRESS: t, 0 I , I Q Ce
P 1 aL ,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.
Justifications•�
/2 3
LDR OR CIO&TRACT SIGNAT DATE
Print Name
STATE OF FLORID •
COUNTY OF
ACKN LEDGED BEFORE ME THIS 94r�—
DAY OF O C�-� ,20�
BY 4-CY e- J r�'/f!YJ 1��. WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED d AS IDENTIFICATION.
t/--2e'0"f1.4 1
STA OF FLORIDA,County of d
AUDREY B.HUMPHREY
= ' +- MY COMMISSION#FF 174772
SIGNATURE F ARY SEALJ ,o EXPIRES:March 6,2019
Bonded Thru Notary Public Undenvrkers
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
OCT 2 3 2017