HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS,D1 51ON
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2300 VIRGINIA AVE
'. ................_.... ..... FORT PIERCE,FL 34982
(772)462-15S3Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: Q :- (? ADDRESS- i
J I ,am requesting that the above permit be renewed. I
u4no rstan�*mtschedule an ss all required inspections for the permit to be finaled_ Further, I
i understand that this is a ONE TIME RENEWAL and the permit shalt expire ShouldI not receive a•
passing inspection during any six month period during the renewal period.
Justi1 ' n
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17
OWNER/BLDR o CONTRACTOR SIGNATURE DATE
la9Print Name
STATE OF FL
COUNTY OF . rT
�f
AC WLED DEL ORE ME THIS DAY OF
$ ( WHO IS PZRSONALLY KNOWN TO MG 0,09
HAS PROVIDED AS IDENTII~ICATION.
CJT4
E OF FLORIDA, ou y of i�i., �a•�
fy SUS31N fiW
L HOPIONSNN8l.Y.
!� 144 COMMl581(7N� M941411
F REX0IRES:De6embat6,V9
� I , � BondedZhnttatanrPubliaUnderrrlisst
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FOR OFFICE USE ONLY:
3 Number of Open Inspections: (�
Total Inspections:
I (Divide open by total to get%of open inspections) i
Percentage:
COriginal permit fee: x%open � $ Rencwal Fee
i Example: [15 divided by $175(permit fcc)x.65-$113.75(rcncwal fcc)
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Revised V21/2014
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