HomeMy WebLinkAboutPermit Renewals I
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUN BUILDING AND.CODE REGULATIONS DIVISION
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2300 VIRGINIA AVE j
girl FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 j
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PERAW RENEWAL'REQUEST
PERMIT NUMBER: I L9 12,—0 Il (P ADDRESS: "1 v3ci C� .
am requesting that the above permit lie renewed. I
understand that I must schedule and pass all required inspections for the permitto be finaled. Further, I
understand that this is a ONE TEVIE RENEWAL and the permit shall,;expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification C\-e 4 ii C ALL—
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O OR CONTFRCTORSIGNATURE DA E
Print Name
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STATE OF FLORIDA
COUNTY OF tirl-- lA4.l c
�` �,,,�" I
ACKNOWLEDGED BEFORE MF THIS U DAY OF N VQJMoe111r' 20 1
BY S•1 VA �. AZ WHO IS PERSONALLY KNOWN TO 1 EE OR
HAS PROVIDED ��! AS IDENTIFICATION.
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STATE County Of
.Rs PV Notary Public State of Florida
Parrish A Nichols
My commission GG 126706
f SIG TURE OF NOTARY SEAL iof noI Expires 0712012921
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FOR OFFICE USE ONLY: —
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Number of Open Inspections:
Total Inspections: j
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ _Renewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014 I'
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