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
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ,I O V` V `[�� ADDRESS: :3 3-2 V-Ad&ef� �J
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 j/n 1'
R/BLDR OR CON RACTOR SIGNATURE DATE
,s� �' CSN c��A/
Yrin Nam
STATE OF FLORIDA
COUNTY OF `n k
ACKNOWLEDGED BEFORE ME TIRS DAY OF 1 V li 20�
BY )�P,rl OZ\ CAAOUB WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L- AS IDENTIFICATION.
STATE OF FLORIDA,County of �,� i✓�Z�
HEATHER BUR FORD
F4
_ ' ;State of Florida Notary Public
SIGNA OF NOTARY SEAL -,
Commission 0 GG 183217
�e My Commission Expires
February 06, 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