HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONSDIVISION
® 2300 VIRGINIA AVE, gyp;
-,-- FORT PIERCE,FL 3492 N.
(772)462-1553 Fax(772)462-157&
PERMIT RENEWAL REQUEST i
PERMIT NUMB'ER: . 1 0(9 N, a5 I ADDRESS: �07�c7 {V C"� t ( Z"I� �j
1, am.requesting that the above permit be renewed. I
understand that I must Whedule and pass all required-inspections for the;perrniV,to be finaled. Further,'I
understand that this is a ONE TIME RENEWAL and the permit shall expire should MI not receive a
passing inspection during any six month period during the renewal period. I' Ii
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Justification
OWNER/BLDR OR CONTRACT SIGNATURE DATE
Print Name
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STATE OF FLORIDA
COUNTY OF �1-, ►��o �.,'; I
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ACKNOWLEDGED BEFORE ME THIS QS DAY OF !PLb 'l; 120 i'Ih
BY • ,I+�.,� � p�,t� WHO IS PERSONALLY KNOWN TO ME �', ,OR!
HAS PROVIDED AS IDENTIFICATION. ^
I LASHAHNA INGRAM
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S OF FLORIDA,County of `+< L�iPsP u��'•; Notary Public-State of Florida
3_•9 1w`_My Comm. Expires Dec 20,2016
Commission#FF 177249
S A URE OF NOTARY SEA °' °tWNll' Bonded through National Notary Assn.
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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 = $ Renewal fee
Example: [1$divided by 23=:65(%)] $175(permit fee)x.65=$113.75(renewal fee) ( I
Revised 7/21/2014
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