HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
VQ' - ID BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
--'- - FORT PIERCE,FL 34982
RECEIVED (772)462-1553 Fax(772)462-1578 6ul�lu„ad 'AjunoD aibni •1s
Nn 2 Q 2018 PERMIT RENEWAL REQUES BIOZ 0 ? /�0;�
ST. I--uGic County, Permitting
PERMIT NUMBER: Z O ' OSCO I ADDRESS: 1 6g ao (i jcade_S C U
I, !:—,,a, n C h 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 1 p m�-� �n e r W Ck Oy k - Ci p S12�E -
• 11 l � a � l �f
OWNER/BLDR(TR_CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF_ eek(',P--,, 1-�
ACKNOWLEDGED BEFORE ME THIS I Q DAY OF M OBJ eM b P ,20
BY M n Ch S n WHO IS PERSONALLY KNOWN TO ME V ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of Pcp' P_GL 0-1 JENNIFER AV I L E S
41.
�State of Florida-Notary Public
SIGNA OF NOTARY Commission #GG 196943
% F F��P� My Commission Expires. ,
� March 15, 2022
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