HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER:1-7 ` ` OOa(CADDRESS: (12,636 PoY(L L a ,l�!,
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I, /am I 1 Lkyy)V-�)' r�a requesting that the above permit be renewed. I
understand that I must schedule andass all re tWed inspections for the permit to be f paled. Further I
understand that this is a ONE TIME RENEWAL and the permit shall epire should 1 not receive a
passing inspection duringany six m�nt�h period the renewal period.
Justification VV�Q �� ALU �-
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OWAft9LDR OR ONT CT R SI ATURE DATE
1��C1'1C 1�t55�--�
Print Name
STATE OF FLORA 1g . .e c
COUNTY OF <.7�"
AW O is DAY OF ,�pt111i11
BY WHO IS PERSONALLY KNOWN TO �\�r1SsiOiS����•�
HAS PROVIDED G C)l• w `L4 lLni
PUBLIC z
STAA OF FLORIDA,County of
i y61 .
SIG T RE OF NOTARY SEAL /�/ OF•FL6�
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FOR OFFICE USE ONLY:
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Number of Open Inspections:
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
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