HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
' J BUILDING AND CODE 'REGI)LATIONS DIVISION
2390 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1
JAN-112018
PERMIT RENEWAL REQ EST
sr. ucie County►permitting
PERMIT NUMBER: :• L.� AUD1tESS: C
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I, am requesting that the above permit be renewed. I
and—crc standt I must schedule and pass all required inspections for the perniit to be finaled. tether,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 c
OWNERLBLDR OR CONTRACTOR SIGNATURE DATE
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STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE METHIS DAY OF_I.f'L'C 0---)b r' 120_j
By WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED _ AS IDENTIFICATION.
,-STATE OF FLORIDA,County of
l _ .��aaY pva��. DEBORAH RUSSELL
SIGNATURE OF NOTARY = , Notary PUDlic-State of Florida
n FF 179630
:,i Comm.Expires Nov 30,2018
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 _ S Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65-4113.75(renewal fee)
Reviscd 7/11/2014