HomeMy WebLinkAboutPermit Renewals C
PLANNING AND DEVELOPMENT SERVICES DEPART NT
•
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE ,A
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST PC 2�
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PERMIT NUMBER: 1 !V J 1 ADDRESS: I DCeciy, 2—,
0�1 L1u.w 5F2"(A /w(,,am requesting that the above permit be renewed. I
understand that P 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 per}'od during the renewal period!_.
Justification ) qv 0,��r t� G(CCISS JI A c �C cevwd
OWNER/BLR CONT CTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS a` DAY OF 20 `1t
BY G {t.tO �-� Q+��1L�' WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED t- fl l-- AS IDENTIFICATION.
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STATE OF FLORIDA,County of «"•:, DEANNA MARIE GIVENS
MY COMMISSION#GG 022023
oe EXPIRES:December 16,2020
SIGNATUREOFNOTA ,Fo ;° BondeiWOWYPublicUnderwiters�
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(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014