HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST'""° 0 U 2017
PERMIT NUMBER: J l �b ADDRESS: t I 1
am requesting that the above permit be renewed. I
understand that Imut 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 re ewal period.
Justification Y'1 r C� G
R/BLDTOR CONTRACTOR SIGNATURE ATE
Prmt Name
STATE OF FLO -� L
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS .S DAY OF
BY tr\el 31ng� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
\STATE OF FLORIDA,County of ��' • `-J •\ ______� �?
\ ;' ;Pga•,,; DEANNAMARIEGIVENS 14'
MY COMMISSION#GG 022U23
SIGNATURE OF NO Y
EXPIRES:December 16,?.020 It
Bonded Thru Notary Public underwiiors!?I
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FOR OFFICE USE ONLY:
Number of Open Inspections: �" �'�1 l .
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