HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- - BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
- -- - FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 =RECEIVEDPERMIT RENEWAL REQUEST
PERMIT NUMBER: '7 0'-OC44ADDRESS:
I, x�w& - ��C�✓�S S` ,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 1/N14faLE 91-0
WNERBLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FL! A
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS , DAY OF �r( 20
BY \AUL 1 V�l'.IV�C�S WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED `� 1„, 1� •L AS IDENTIFICATION.
STATE F FLO A,Coun o
KAREN S. NIELSEN
"P ,r ry
S GNATU OFNOTARY S ^'__ Commission �F 115
My Commission Expires
June, 12. 2018
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage: 0�
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