HomeMy WebLinkAboutPermit Renewals ' I
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
COUNTY
L 2300 VIRCINIA AVE
-- - FORT PIERCE,.f~L 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAI'REQUEST
F9RW-T.NUMBER: 126S--()0 ADDRESS: '0 -r G t � �..)ji
-. � ,am ri:gilesting that the above permit be renewed. I
understand t aI 1 must schedule and pass all•regliired inspections for the permit to be fulaled. Further,I
understand that this is a ONE TIME RKNEWAL and the permit shall expire should I not receive a
passing inspection during any six month Period during the renewal period.,
r tification
bjc)uem 3rd I
NT O DATE j
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Print amG �j►�r,P,c� CF WtINEWALTM
MY COMMI6.$ION 8 00 071154
EXPIRES;May J4,2021
. ,�,�. � g'�oP F<���8aded i'tw 8udgat Notary SaM0�8
STATE OF FLOI�! A
! ! cowN ly Or
ACKNOWLEDGEO BEFORE MEIMS � j3AY4pkoy mV ,Zq�
BY _...)e L:� , r� i1,5�,�++{�) M1WI3019 PERSONALLY KNOWN To'ME_. !,OIL
HAS PROVIDED 'AS WRNTIFICATJON.
STATE OF FL,01? IA,County 9
giRS3i1NEWWON
,�f+IIY COMMIS3ft7N tl 00 D7i161
SICIINATUPX UP NOTARY * EXpIpES:May 14,2021
I ��oa��QSf3arOeaTtwt3udg9�NOltMyServfolo
FOR OF>FICE-VS> ONLY:
N=bpr of Opta•Inspactions_
Tdtal Inspcctions:
` (Divide-open by total to•{ret%.of upon,inspeCUQns)
ji Percentage:
Original pertnit fee:_ x%open - 9 Renewdl fee
Example: [15 divided by 23=.65(%)] S175(pennit fee)x_65=9113..75(renewal fbe)
Revisatl.7/211?014
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