HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
e BUILDING AND.CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 =RECEIVED(772)462-1553 Fax(772)462-1578PERMIT RENEWAL REQUES
_ C p J I
PERMIT NUMBER: -SZ- `1712 �ADDRESS: 7D L a hqs 7'o b L)I",
I, � ,am requesting that the above permit be renewed. I
understand t at I must sc edule 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
RB R R CONTRACTORSIGNATURE T
r-
Print Name
STATE OF FLO A
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS I DAY OF ��«e,��_ 20�
BY,�O(�; g- I( �7� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �� L AS IDENTIFICATION.
STATE 0 FLO A,Coun of
.r4 L 0Af
KAREN S. NIELSEN
4os+nue.
S NATURE 0 NOTARY =a ��-:State of FloriA tar Public
'. commission �C 207484
�� pAy Commission Expires
June 12, 2022
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 = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014