HomeMy WebLinkAboutPermit Renewal ONNIIMEMENEM PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY BUILDING AND CODE REGULATIONS DIVISION
F i1 O IRd D R =- — 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 '0e,. l
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PERMIT RENEWAL REQUEST °Q;',0
PERMIT NUMBER: styt-t--,O5ts, ADDRESS: 1o5( SI"N OC+ a IP �,(„ Ir
,am requesting that the above permit be renewed. I
understand that I must schL4tle and pass all required inspections for the pern}it 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 -cinbifp( S ve -A-c) �
OVOCTORiukc4/
SIGNATURE D TE
iejPrint Name
OF FLORIDA
COUN ;'€
COUNTYYOF
ACKNOWLEDGED BEFORE ME THIS I DAY OF Dere-toe/L.) 20 1 g.
BY„Ti/ )fl y tat., WHO IS PERSONALLY KNOWN TO MEV , ,OR
HAS PROVIDED AS IDENTIFICATION.
ATE OF FLORIDA,County of 5+•
t ti, •
otPaY Abe%; DEBORAH RUSSELL
• .S ��`;� =•2; `.°= Notary Public-State of Florida
S " TURF OF NOTARY "ss: F:ura . E pemission # FF 179630 5
,,o F��o-• My Comm.Expires Nov 30,2018 ro
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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
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