HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
® BUILDING AND CODE REGULATIONS DIVISION
.^ ., 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: G�v ADDRESS:
am requesting that the above permit be renewed. 1.
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
at s c.e lam"-�el,
OWNERIRLF R/CONTRACQTO TURE DATE
Print Name
STATE OF FLO
COUNTY OF t�! v^�
ACKNOWLEDGED
BEFORE ME THIS j DAY OF ail um r� 20
PIrBY /t� �� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STAT RIDA,Cou Gi ,tr ro �
O Notary Public State of Florida
R
S Tt1RE OZF SEAL John Edward Gifford
`9 My Commission GG 147815
�}a�� Expires 12/17!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=.65(%)l $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014