HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
'COUNTY
" J BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 VE
(772)462-1553 Fax(772)462-1578
AN 2018
PERMIT RENEWAL REQUEST Permlttin
[:REC:E
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PERMIT NUMBER: ' flgt'�QD�Q ADDRESS: 'T� �1 (f) ( (� � let%�
I, r-0-N T� ,am requesting that the above permit be renewed. I
understand that ust schedule and pass all required inspections for the permit to be finaled. Further, I
understand that t Is is a ONE TIME RENEWAL and the permit shall expire should 1 not receive a
passing inspection during any six month period during the renewal period.
Justification
1
OWNS R OR CONTRACTOR SIGNATU 1 DATE
1
Print Name
_ STATE OF FLORIDA
COUNTY OF �-�:LLtC c
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 (g
BY C� l...F!�l7 ` WHO IS PERSONALLY KNOWN T ME�,OR
HAS PROVIDED AS IDENTIFICATION.
S TE OF FLORIDA,County of -<
8I0Z'0£noN sajldx3 wwo0 FW -0o ,"
SIGNATURE OF NOTARY SEAL 0£96LL 33# uolsslwwo0 �s
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FOR OFFICE USE ONLY: =.� y Pu State
Cpm of Florida
��FOF FIOa••,• MY Cornmission #FF 178630
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Number of Open Inspections: m. Expires Nov 30 2018
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(%)] S I75(permit fee)x .65=$113.75(renewal fee)
Revised 7/21/2014