HomeMy WebLinkAboutPermit Renewals Apr 17 18, 12.13p Veterans Fence 7728772650 p.2
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2► u 'f 2300 VIRGINIA AVE
FORT PIERCE,rL 34982
(772)462-1563 Fax(772)462-1578
PER. IIT RENEWAL REQUEST
PERMIT NUMBER-&I—� !?oS'�o� ADDRESS: f s� Iuc
1. J� i ��
��l�zf .`f ;rt"•G^' ,am requesting that the above permit be renewed. I
Understand that I must schedule and pass all required inspections for the permit to be foaled. 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
I!lq q1/1 1//S
OWNERIBLDR OR CONTRACTOR SIGNATURE —�DATE
Print Name
STATE OF FLORIDA. ,
COUI,'7Y OF <
ACKNOWLEDGED BEFORE ME THIS DAY OF r 1 .20
11 r 1
BY ��?( f t) ��, �: I��0t�1L ,y WHO IS PERSONALLY KNOWN TO.'VIE OR
HAS PROVIDED �T10
On f cPrpF i
12
STAIT_OFF R(DA.Courcy of 7
SIG.'An]RE OFNOTARY F {. M;�' �' $
yo a y Pub
' w �
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total inspections:
Divide open by total to get%of open inspections,
Percentage:
Original permit fee: x%open = S Rencwai fee
Example: [I5 divided by 23=.65(%)] S175{permit feel x.65--S]13-775(renewal fee)
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