HomeMy WebLinkAboutPermit Renewals PLANNING 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
1 �V� � —�
PERMIT NUMBER: ADDRESS;> � � N►J
am requesting that the above permit be renewed. I �-A-
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 six month period during the renewal period.
Justification
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OWNERBLD R ONTRA TOR SIGNATURE DAT
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF ��e G ,20
BY .�L I �I �� j'� L L WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED 1 C AS IDENTIFICATION.
STATE OF LORIDA,County of
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SIGNATtU OF NOTARY SEAL
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----------- - qt`,�i --�dTd�d"fhru Notary Public Underw b,
FOR OFFICE USE ONLY:
Number of Open.Inspections:
Total Inspections: �- .0 a
(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