HomeMy WebLinkAboutPermit Renewals 03-25-18; 23:21 ;From: To:7724621578 ; 7724618722 # 3/ 3
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
w _ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUES sT �Q,Q2 SFO '
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PERMIT NUMBER: I101 O a S ! ADDRESS:
I, ,am requesting that the above permit be renewed. I
understand that I must sehe a 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 o4a j-�J �f -� �C�y11 1 G f-��)�� tom., cr
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NER/BLDR OR CONTRACTOR SIGNATURE YATE
Pant Name
STATE OF FLORIDA `
COUNTY Of S7" I1/Cl
ACKNOWLEDGED BEFORE ME T141sz DAY OF�111)A1411;�_- '20—Z42
BY �4� PS e-c WHO IS PERSONALLY KNOWN TOME_L,--' ,OR
HAS PROVIDED AS IDENTIFICATION,
STATE FLORIDA,C unty of '
,`':K:•"'''• SUSAN MONTENEGRO
MY COMMISSION#GG 089099
'IG ATURE OF NOTARYEXi�1 ,� Aprj{2,202 1
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j Hondod Ttn Notary Public Uc149iwrdm
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FOR OFFICE USE ONLY:
Numbcr of Open Inspections:
Total Inspcetions: .;
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: (15 divided by 23=.65(1/4)] $I75(permit fee)x.65=$113.75(renewal fee)
Rcviscd 721/2014