HomeMy WebLinkAboutMisc Letters 0
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
l -Lt; .a 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: / y�- O D ADDRESS: ( I / OL
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, 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
OWNER/BLDR OR CONTRACTOR SICNATURE DATE
Print Name
STATE OF FLORIDA
..,,A
ACKNOWLEDGED BEFORE ME THIS DAY OF I �� 20 l 7
BY A—n( � �-� G e 0✓WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED FLA A D D`� �I+ 0, AS IDENTIFICATION.
STATE OF FLORIDA,County of
ol
SIGNATURE OF NO RY SEAL
-----------------------------------------------------------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY:
Number of Open Inspections: ' , Q D
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)
L2pu0 NO,]"JIMN ni41 paPuoBRevised 7/21!2014OZ'9 4Pj�W S3d1,Ldd#NOISSiVVVUC0 IIN3NHdVV0H A3 j0(llL .aFd7 ;.•