HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
► - 2300 VIRGINIA AVE
FORT PIERCE,FL 34982 -- ___
(772)462-1553 Fax(772)462-1578 RECEIVED_
PERMIT RENEWAL REQUES FEB 0 5 2018
ST, t_uCjo jaunty, Permitting
PERMIT NUMBER: / 7196 045' ADDRESS: fyc/w-iwL zw—ftr X31 vy- e0-1y
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am requesting that the above permit be renewed. I
understand that I kust 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
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OWNS LDR OR CONTRACTORS NATURE DATE
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Print Name
STATE OF FLORID /
COUNTY OF G UCS /''
ACKNOWLEDGED BEFORE ME THIS_�DAY OF f L/4 .201990--
BY '1( / 1�MS WHO IS PERSONALLY KNOWN TO ME v1 OR
HAS PROVIDED T AS IDENTIFICATION.
STATE OF FL DA,Countyof T C-0
KAREN S. NIELSEN
+° Commission# FF 115637
SICNATME UF TA '� *_
My Commission Expires
June 12, 2018
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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 = $ -- "` .6.6Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.6e��e5=$113.75(renewal fee)
Revised 7/21/2014