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 =RECEIVEDPERMIT RENEWAL REQUEST
PERMIT NUMBER. v `-1' ADDRESS: l `�'—I � `�I� C��� ✓
I, :benf\i5 Zai'e K ,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/BLRY OR CONTRACTOR SIGNATURE DATE
.Denn15 Zaw
Print Name
STATE OF FLORID
COUNTY OF, �rJ C)e
nd
ACKNOWLEDGED BEFORE ME THIS A i` AY OF ,20 I o
BYWHO IS PERSONALLY KNOWN TO ME V OR
HAS PROVIDED AS IDENTIFICATION.
%GNATURE
4OFARY
f ��, Uicle
COLI:ER! SULLIVAN
SEAL '= MY COMMISSION#GG071535
EXPIRES February 09,2021
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