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HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT s BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578 PERMIT RENEWAL REQUEST r. PERMIT NUMBER: / U V ADDRESS: o Yl 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 1311 OWNEkALDR OCONTRACTOR SIGNATURE DATE a n Print Name STATE OF FLORIDA COUNTY OF X ACKNOWLEDGED BEFORE ME THIS DAY OF 20 1 U BY f)7 l CARE L C © N 12-A WHo IS PERSONALLY KNOwN TO mE ,OR HAS PROVIDEDAS IDENTIFICATION. STATE OF FLORIDA,County of ., SI OF NO ASERI RY �*= MYUpDR�B• MPH • HU ''F••oPg� Exfil SS/ON fF 17y A„P�.• 8o�ad>'nN March s,20)72 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