HomeMy WebLinkAboutPermit Renewals 02/26/18 02 : 33PM GMT-05 : 00 '8664807498 ' —> 7724621578
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISIO
NTY
2300 VIRGINIA AVE
_..._.::.....:....._..-... FORT PIERCE,FL 34982 R�r
(772)462-1553 Fax(772)462-1578
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PERA TT RENEWAL REQUEST
PERMIT NUMRER.1 tL0,— ADDRESS_ A Rt,,D w tl r
1, age 31,kt r\ ,am requesting that the above permit be renewed. I
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
- a ixc � t
'NER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLOBADA
COUNTY OF LDC4, r
ACKNOWLEDGED BEFORE MF.THIS�.DAY OF 00f. 1''[ ,20�
BY V'P WHO 1S tE! ALLY KNOWN TO 'OR
`^-.6N'•�---tea,
HAS PROVIDED AS IDENTIFICATION.
STATI; F A, of C-t�— _ �..+.+
•;?,' SHERRiKELLEY
Commission#FF 999218
SIGNATURE OF NOTARY SFAo:Expires October 4,2020
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Bowed ThmTroy Fain lnaurante8003857019
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:^_
Original permit See: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)} $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014