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HomeMy WebLinkAboutPermit Renewals I i I PLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND.CODE REGULATIONS DIVISION - Late IN I 2300 VIRGINIA AVE FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578,, i J PERMIT RENEWAL REQUEST I PERMIT NUMBER: ©7— �70 ADDRESS: ?2- am requesting that the above permit be renewed. I understand th t I must schedule.and pass all required inspections for the permit'to be finaled. Further, I understand that this is a ONE THAE RENEWAL and the permit shall.expire should I not receive a passing inspection during any six month period during the renewal period. Justification I OWNER/BLDR OR CONT OR SIGNATURE DATE i T Print Name STATE OF FLORIDA COUNTYOF I, ACKNOWLEDGED BEFORE ME THIS_ DAY OF A-V V 20,' BY -PQls'!-16 IPt�,••�..,P WHO IS PERSONALLY KNOWN TO ME ,OR I I HAS PROVIDED AS IDENTIFICATION. S OF FLORIDA,County of I' I SI A OF NOTARY 'SE LASHAHNA INGRAM ;'2° ` ^ I'Notary Public-State o}Florida °-�y Comm.Expires Dec 20.,201x . FOR OFFICE USE ONLY: ,N �c >°���+�`'` Bonded through National Notary Assn. i _ I Number of Open Inspections: Total Inspections: II (Divide open by total to get%of open inspections) Percentage: j Original permit fee: x%open = $ Renewal fee j Example: . [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee) Revised 7/21/2014 ' I I