HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
- - - — ' FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: { �Vu ADDRESS: 0�1u.
I, Demi's z2CeIr" , 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
OWNER/BLIaV,OR CONTRACTOR SIGNATURE DATE
Mhos ZaceK
Print Name
STATE OF FLORID `
COUNTY OF�. � �d
ACKNOWLEDGED BEFORE ME THIS� AY OF�� 1 { ,20_[b
b
BY 1 L�� � WHO IS PERSONALLY KNOWN TO ME V OR
HAS PROVIDED AS IDENTIFICATION.
%GNNATLTRF-
FLORID o f �, Luc
OF ARY sE �?"�°�8��, COLEEN SULLIVA
_ :+. •c MY COMMISSION#GOG�0715 5
= ., EXPIR2021
ES February -2021
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