HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
--- FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ADDRESS:
I, Demi"s , 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
O'WNER/BL OR CONTRACTOR SIGNATURE DATE
finis ZaceK
Print Name
STATE OF FLORIDAL,
COUNTY OF 5 f. �e f P rid
ACKNOWLEDGED BEFORE ME THIS SjnAY OF �(y 20
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BY �ab _ WHO IS PERSONALLY KNOWN TO ME V OR
HAS PROVIDED AS IDENTIFICATION.
%GNATURJEAR
f G�. UCA6
>eY?JB�n, COLIEEN SULLIVAN
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MY COMMISSION#GG071535
EXPIRES February 09,2021
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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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