HomeMy WebLinkAboutPermit RenewalsPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
z
PERMITNUMBER:0 P r ADDRESS: Jell-) 'Ve
am requesting that the above permit be renewed. I
understand that I must 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 ix month period during the renewal period.
Justification Ru j- 94 ma--- - I
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Colr7-
Print Name
STATE OF FLORH)�-C.'
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 40 DAY OF 20
BY S�WHO� OR
6PERSONALLY KNOWN TO ME
HAS PR6viDED AS IDENTIFICATION.
ST OF FLORIDA un f W.`0 If r—
Omm,,, CASEY D FRE j Florida
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'tty F0,51" Public - State
ktacy
,Sp. Dec 1, 2017
SIGNAT�r 140TAY Al'�. Q�y -'c Expires
V Commission # FF o69924
Assn.
OF Bonded Through National Notary
— ---- — ------
FOR OFFICE USE ONLY:
Number of Open Inspections:
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(0/o)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised MU2014