HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISIO
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST 10Jj
PERMIT NUMBER: !/ /615i ADDRESS: ((��TV VVI
I, U' 1 m requesting that the above permit be renewed. I
understand that I must schedule afid 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 renewal period. /
Justification di J
/)i-) - yI[; lid' Ll Y) (S , Ci(JE�U1 �IAC�� r
OWNERBLDR OR CONTRACT SIGNATURE DATE
r�
75,M), V iPrint Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS `k DAY OF Q e C 2011
BY *'0 r4\ 4 "`fl�41 s G WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of 5"� 1�c% DEANNA MARIE GIVENS
MY COMMISSION#GG 022023
SIGNATURE OF NOTA
ca *= EXPIRES:December rvM
"'•''F op
Bonded 1bR taryPublicUndawrte's
MY
---------------------------------------------------------------------------------------
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(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014