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 P ADDRESS: 1 ) �U11 J�)
I, ,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
O R/BLDR OR C NTRACTOR SIGNATURE AT
Print Name
STATE OF FLORIDA
COUNTY OF 1 Q
ACKNOWLEDGED BEFORE ME THIS DAY OF 20/ I
BY e WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE O LORIDA,County of
SIGNATURE OF NOTPY SEAL
FOR OFFICE USE ONLY:
•�;.'F•,, AWREY 9.HUMPHREY
Number of Open Inspections: _;g MY G0MMISSION#FF 174772
Total Inspections ^, EXPIRES:March 6,2019
a ''�Rf„fa' BondedThNNoleryPubC�cUndenvriters
(Divide open by total to get /o 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
APR 17 Zp�g
[RECEIVA]FED
itting DepaLucie Count