HomeMy WebLinkAboutPermit Renewals OCT-25-2018 THU 02:30 PM CT"ITRAL SCHEDULING FAX No. 3212686138 P- 001
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PLANNING AND DEVELOPMENT SER'V'ICES DEPARTMENT
RUILDXNG AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 .Fox(772)462-1578
PERMIT RENEWAL REQUEST
PERT NUMBER —,R4 My
dVIIADDRESS:
am requesting that the above permit be renewed X
understand that I must schedule and pass all required rns ectlons-for the permit to be filed. Further,I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing insp on during any sig month period (during the renewal period.
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OWNER/ L R OR CONTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLORID
COUNTY OF
AC OWLEDGEI)BEFORE ME THIS DAY OF
i3 U WHO I5 PERSONALLY KNOWN TO ME ,OR
HAS F$OVIDED AS IDENTIFICATION.
TAT OF FLORIDA,CoWity of �
ro, CatherineKongep
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SIGNATURE OF1vOTA1tY $ *•. " 60mmi0m#FF17237'2
x •, VWAres:OCT 28,2018
80NDHDTHR
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FOR OFFICL USE ONLY: ` '>IIIY�e `ILIO
Number of Open lnspectims:
Total Inspections-
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%opeu = $ Renewal fee
Example: [15 divided by 23=_65(%)] $175(permi fee)x.65=$113.75(renewal fee)
Revised MI/2014