HomeMy WebLinkAboutMiscellanious Letter _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND'CODE REGULATIONS DIVISION -
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: I"?V7— 01 D / ADDRESS: OoS CL-+/b5 P&-(k V `V4 34 _l r4 Pehce FL
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
OWNE LDR OR CONTRACTOR SIGNATURE DATE
--ijec
Print Name
STATE OF FLORIDA
COUNTY OF j n/
ACKNOWLEDGED BEFORE ME THIS—DAY OF ��! ,201
BY V1 ler' e h L° - WHO IS PERSONALLY KNOWN TO ME ,OR
HASP IDED AS IDENTIFICATION.
STATE OF FLORIDA,County of `
AUDREY B.HUMPHREY
SEAL + +- MY COMMISSION 0 FF 174772
SIGNATURE OF NOT ; EXPIRES:March 6,2019
C� ,:;:C• Bonded Thru Notary Pubric Underwriters
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