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HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT 11 9 77 T_9 tr BUILDING AND CODE REGULATIONS DIVISION �COUNTY 2300 VIRGINIA AVE .FORT PIERCE,FL34982 (772)462-1553 Fax(772)462-1578 PERMIT RENEWAL REQUEST Ap4A1 PERMIT NUMBER: /J0 0 bS&' ADDRESS:In ©� a`Q` • M 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�c ging an six month period during the renewal period. Justification 13, OWNERBLDR OR CO CTOR SIGNATURE DATE CoAcon Print Name STATE OF FLORIDA COUNTY OF ACKNOWLEDGED BEFORE METHIS DAY O 20 b BY i (019 /\ 6-0/ &0 IS/PERSONALLY KNOWN TOME ,OR HAS PROVIDED AS IDENTIFICATION. STATE OF FLORIDA,Co ty of SIGNATURE OF tyTARV. SEAL FOR OFFICE USE ONLY: Number of Open Inspections: Total Inspections: Sale, : AUDREY 19.HUMPHREY 174772 (Divide open by total to get%of open inspections) MY PIRMISSION#F,2019 EXPIRES:March 6,2019 Percentage: SnMlad Thru Notary Pubric Underwriters Original permit fee: x%.open = $ Renewal fee Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee) Revised 7/21/2014