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: 17�� '��D ADDRESS: '57-1-77�7Z
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
OWNNEER_/BLDR R CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORID
COUNTY OF � L
ACKNOWLEDGED BEFORE ME THIS )a DAY OF F 20 1
By , OWHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STA FLORIDA,Coun
SIGNA C N ARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections: `� " , *8
''i AUDREY S.HUMPHREY
Total Inspections: _ _ W COMMISSION#FF 174772
a:, `t EXPIRES:March 6,2019
(Divide open by total to get%of open inspections) • hf�1O`s' BondedTh.Wt'aryPubfieUndermfters
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/212014