HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
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PERM T NUMBER: 1 -'7a3• 5701 ADDRESS: Z-70
I, A r-J psy kl4oWA 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 h- Gz �;'-1
ER/BLDR OR CONTRA C R SIGNATURE DATL
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Print Name
STATE OF FLORIDA
COUNTY OF ✓5!t- L UGJG C
ACKNOWLEDGED BEFORE ME THIS DAY OF /'rj/y�, 20�
BY )<11—MAV WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED >_ AS IDENTIFICATION.
STATE OF FLORIDA,County ofL-A/G,AC
HEATHER BURFORD
SIMATURE OF NOTARY SEAL State of Florida-Notary Public
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Commission N GG 183217
,#�� My Commission Expires
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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