HomeMy WebLinkAboutPermit Renewals From:Alex Lopez Fax:(772)621-5959 To: Fax: (772)462-1578 Page 2 of 3 12108/2017 4:44 PM
_ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
1 BUILDING AND CODE REGULATIONS DIVISI9
2300 VIRGINIA AVE r n
FORT PIERCE.,FL 34982
(772)462-1553 Fax(772)462-1578
SEC 12 2017
PERMIT RENEWAL REQUEST 5t. Pcl3;ltl1 TI/�rG
Lucie Couilt,., F:-
PE T NUMBER: � ADDRESS:
I, t�AZ 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,l
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
/
WNER/BLDR OR CONTRACTOR SIGNATURE DATE
Ono t4 e-Alj C-114-
Print Name
STATE OF FLORIDA
COUNTY OF ST
ACKNOWLEDGED BEFORE ME TfIISTH DAY OF `� 20 t
BY WHO IS P ONALLY KNO TO ME OR
HAS PROVIDED AS IDENTIFICATION.
AIGNATURE
Y
OF FLORIDA,County o
OF ROTARY Commission 0 R'945187
r EleQia November 19,2019
Bonded thru Aaron 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(°/a)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/1014