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HomeMy WebLinkAboutpermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT � BUILDING AND CODE REGULATIONS DIVISION _, 2300 VIRGINIA AVE - FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578 '4Pf O IINN ANY PERMIT RENEWAL REQUEST t`4ceoo00, C%T4 017 PERMIT NUMBER: / lJ 1 ©163 ADDRESS: h ) 7 J P J31io 1 ^I n 1 V Ep— 1�r4 t, 6A"n 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 1 ,=-R l)1 11 /IDT C-L6&9-:Jl, P NAk-�Cj N 1, 'o b,CIA-1F9 tz. 11 +�-f3 TD C,l Dc U uT �T L� � r,�� �p 41c) z,01 % OWNERBLDR OR CONTIMCTOR SIGNATURE bATE AQ A Print Name STATE OF FLORID COUNTY OF St . D k c,�e ACKNOWLEDGED BEFORE ME THIS�_DAY OF BY Aflc�, [ WHO IS PERSONALLY KNOWN TO ME OR HAS PROVIDED t'D AS IDENTIFICATION. STA OF FLORIDA,County of LU t L SIGNATURE OF N ARY SEAL FOR OFFICE USE ONLY �ti .. AUDREY B.HUWFIREY MY COMMISSION 0 FF 174772 Number of Open Inspections: EXPIRES:March 6,2019 fp ;dondedThruNotaryPbcUnden ers 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