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
3 0 nPERMIT RENEWAL REQUEST [:RECEIVED
gdnty' permitting
PERMIT NUMBER: I 04— Q 2'u PADDRESS: O 6) ver pr
Lle' ,am requesting that the above permit be renewed. I
unders and 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 IPC cr 1 o
OWNER/BLDR ORC NTRACTOR SIGNATURE DA E
Print Name
STATE OF FLORR 1 `
COUNTY OF o
ACKNOWLEDGED BEFORE ME THIS � O DAY OF �J k� �/ 20_L�2
BY " I �l �rL ,�, WHO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED Yt, D AS IDENTIFICATION.
f
S�EOJF' RI A,Coun o£
SIGNATURE 0 NOTAR
KAREN S. NIELSEN
c=� ,State of Florida-Notary Public
Commission #GG 207484
---_-------- ------------ � �'-"7dty�txrtrrr>Tssi"orrEx'Rires ---_---_------------------
FOR OFFICE USE ONLY: °��"� June 12, 2022
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