HomeMy WebLinkAboutPermit Renewals 10/03/2018 10:37 5614932701 ECM PAGE 01/03
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
" �- L BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGXNIA,AVE
FORT.'PIERCE.FL 34982
(772)462-1553 Fix(772)462-1578 [:R:E:CEIVED -
PERMIT
RENEWAL REQUES 3 2018
ty, Permitting
PERMIT NUMBER: G � ADI )ESS: `J V � `"
>t,
i—�Om I am,requesting that the Above permit:be renewed. I
understand that I must schedule:and pass all required inspections for the permit to be f.naled. 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 10Q �
Nod 'Toeyllu Ir
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O E LDR CONT C STGNATURS DA.TT~
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Print Name
STATE OF FLO A
COUNTY OF
ACKNOWLEDGED BEFOREyMIF,,THIS DAY OFCQ
13YQ-� W140 TS PERSgNALL3i:. NDWN_TO MF ,OR
HAS PROVIDED _ AS I.DENT,I.FICATION. �a���0�dg
S 1.ORT.DA.County of —� J1.I V110,IZP
SIGNAT 6 OF N SEAT,
�`�`S'htTE4�`�.•
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections: f _
(Divide open by total to get%of open inspections)
Percentage; _ (�
Original permit fee: x%open = $��_Renewal fee
Example: (I5 divided by 23=.65(%)] $1.75(permit fee)x.65=$113.75(renewal fee)
Rcviscd 7/21/2014