HomeMy WebLinkAboutPermit RenewalsPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
LIS aJ-1 - IFJi�" - BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER:5 C— 16 ADDRESS:
1, am requesting that the above permit be renewed. I
unaerstand that I must schedule and pass all required inspections for the pen -nit 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 renewal period.
Justification
OWNE LADRO C OR SIGNATURE
U
Print Name
DATE
STATE OF FLORIDA
'� -
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS C:)\C DAY OF 20
WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
OF FLORIDA, County of
SIGNATURE � NOTAR
ANGELA M HUFF
Notary Public - State of Florida
FOR OFFICE USE ONLY:
My Comm. Expires May 27, 2019
Bonded through National Notary Assn.
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 by23=.65(%)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 7/21/2014