HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fa:(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER:, U� �� / ADDRESS:1 5 " ". k TOI;\MQ
I, �z ,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
BLDUR O TRA OR SIGNATURE DATE
Print Name
STATE OF FL D
COUNTY OF 4
ACKNOWLEDGED BEFORE ME THIS 1 DAY OF .20—VD--
By
20—VD--
BySjK, HO IS PERSONALLY KNOWN T .OR
HAS PROVIDED AS IDENTIFICATION.
COLEEN SULLIVAN
0 D Co MY COMMISSION#GG071535
E=XPIRES February 09,2021
GII OF SEAL '
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 7/2112014 9 2018
Department
permitting rte FL
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