HomeMy WebLinkAboutPermit Renewals 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: j ( � -OOld I ADDRESS: "00 poucW� C'r
I, :: Ac.vt ES L E/ z 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 ERYBLDR CONTRACTOR SIGNATURE DATE
77-1��
Print Name
STATE OF FLORJDA
COUNTY OF 'N •L4"N
ACKNOWLEDGED BEFORE ME THIS DAY OF 5 20 1�
BY 5 a'vfl-#-A-" `'4 T�� f WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED ` AS IDENTIFICATION.
TATE OF FLORIDA,Cou;1t� �'
E!W -"
"MARI[GIVENS �
COMMISS10 N k GG 02023
:;E.,•,•P EXPIRES:
SIGNATURE OF NOTA(AY "°.`..°'' Bonded Thru r�+rber 16,2020 1S
ry ublic Unde;u:,ita
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