HomeMy WebLinkAboutPermit Renewals I I
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! PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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v BUILDING AND CODE REGULATIONS DIVISION
2306 VIRGINIA AVE I i,
- — FORT PIERCE,FL 34982
(772)462-155.1 Fax(772)462-15x8
PERMIT RENEWAL REQUEST
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� PERMIT NUMBER: ("'Z D LI" 05(oq ADDRESS:
If
I, rA i Q C-0A+C-eA 1 ,am requesting that the above permit be renewed. I
i understand�t ^I must schedule and pass all required inspections for thle permit to be finaled. Further,I
understand that this is a ONE TIME RENEWAL and the permit shall1lexpire'shoul i I not receive a
( passing inspection during any six month period during the renewal period.
Justification o l.�")6i c-&, 717-, AiA.8?n ate-%0
OWNE �
R OR CONTRACTOR SIGN DATE i
C-00'.447C'W �I
Print Name
STATE OF FLO
COUNTY OF I '
ACKNOWLEDGED BEFORE ME THIS 1 Le-tfiDAY OF 1 ,2;0 i
i
gy W
,
�("• � ,�, �(,.��„J HO IS PERSONALLY KNO TO NtE�OR
HAS PROVIDE ASI IDENTIFICATION.
ATE OF FLORIDA,County of
� �pgPR�p</@��p; DEBORAH
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SIGNATURE OF NOTARY E °�: : Notary Public�" ' Commission Nf. C 4%' My Comm.Expire
I ' FOR OFFICE USE ONLY: i
Number of Open Inspections:
Total Inspections: !.
(Divide open by total to get%of open inspections)
Percentage: j
Original permit fee: x%open = $ Renewal fee ! i
Example: [15 divided by 23=.65(°lo)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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