HomeMy WebLinkAboutPermit Renewals From:Mike " . Fax:(772)871-0980 To: Fax: (772)462-6443 Page 2 of 2 11I07I2017 4:40 PM
__. PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462.1553 Fax(772)4624578
PERMIT RENEWAL.REQUEST
TMBEDI -Q -PERM
t,wi w(111 1 �H P,SaSl d ?t 'rr_) am requesting that the above permit be renewed. I
understand that t must schedule and passel 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 ^ou ''fes ,,&..�in
OWNE"LDR OR CONTRA OR SIG A E DATE
Print Name
STATE OF FL IDA
COUNTY OF :. :C+_
1
ACKNOWLEDGED BEFORE ME THIS_�_DAY OF
4-101S PERSONALLY KNOWN'rQ ME_„ � .OR
HAS PROVIDED AS.IDENTIFICATION,
TATE.OF FLORIDA,CQutity of STr1 Raleigh Short
qt -,NOTARY PUBLIC
---- $ ._ STATE OF FLORIDA
IGNAIVR� NO Y SEAL COmm#GG 148342
r�hcE 91e Expires 5/25/2021
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.=-.65OXo)] $175(perm t fee)x.65=$113,75(renewal fee)
Rev=4 7/21!2014
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