HomeMy WebLinkAboutPermit Renewals ' PLANNING AND DEVELOPMENT SERVICES DEP TMENT
t BUILDING AND CODE REGULATIONS DIVI ON
2300 VIRGINIA AVE RFc
FORT PIERCE,FL 34982 Fj(/�
(772)462-1553 Fax(772)462-1578 ST 441 O
Z�0/1y
PERMIT RENEWAL REQUES
Pee
PERNVT NUMBER;,G 11 O 5 OWADDRESS: a?jj I ( � v"R ail
1, e ,am requesting that the above permit be renewed. I
understand Mat I must"schledule 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 durin the renewal period.
Justification CUS t*f r • jp_l- eck C/
/— /Z —'l 6'
ER/BL OR CON CTOR SIGNATURE DATE
N%k\I-AP L-AAa r
Print Name
STATE OF FLORIDA ,
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OFyl V 20 1�
BY WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED L-- AS IDENTIFICATION.
TATE OF FLORIDA,County of <A' `-V C��� ; o"•,, DEANNA MARIE GIVENS
MY COMMISSION#GG 022023
` k EXPIRES:December 16,2020
SIGNATURE OF NO RY ;p'.,�� Bonded Thnggxg Pubiic Underwrite's
_—--------------------------------------------------------------------------------------------------------------------------------------------
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 7121/2014