HomeMy WebLinkAboutMisc Letters 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: ADDRESS: 4/ 7—um&"y
I,`k"y 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
OWNER/BLD ONTRACTOR SIGNATURE DATE
m f�c
Print Name
STATE OF FLORIDA `
COUNTY OF
ACKNO LEDGED BEFORE ME THIS DAY OF 20 .
B -A (i}�1. Q WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDE �-l� AS IDENTIFICATION.
STA7;F FLORIDA,County of
/2_4t tidy •' WDSEY"I HUMPHR
SI ATURE F VARY -jvU) S `' EXPC�RES March 6,��92
; s? BandedThruNotadPuMcUnderartiters
R`�''
FOR OFFICE USE ONLY: 1n ,n �n
Number of Open Inspections: /D v v V
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