HomeMy WebLinkAboutPermit Renewals f
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Ru PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS'DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-15781
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PERMIT RENEWAL REQUEST !
PERMIT NUMBER: 6 6 QS L/ ADDRESS: 1 /�,L}
I; rs R f Cr �ixr E Ru l�jam_,am requesting that the al dove permit be renewed. I
understand that I must schedule and pass all required inspections for theipermit to be finaled. Further,I
understand-that this is a ONE-TIME RENEWAL and the permit's all expire sliauld I not receive a
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passing inspection during any six month period during the renewal period.
Justification f�1c e i� ALR Z
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OWNERJBLDKOR CO RACTO I RE DTE ! �—
Print Name
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STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS "`I DAY OF_ Ih�� -- 2011-1 n
BXQ£ Ct+�
\ph rt WHO IS PERSONALLY KNOWN TO ME 'i�, rOR SNAFINA INGRAM
;:�1ra`�"B1rr Public State of Florida
HAS PROVIDED �} NExpires Dec20.2418AMOVIN
Commission#FF177249
�= Assn.
ATE OFFLORIDA,C ntyofop RO �: BondsBthroughNationalNotary
SI ATURE OF NOTARY 16 , SEAL I i
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
r (Divide open by total to get%of open inspections)
Percentage:
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 �
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