HomeMy WebLinkAboutpermit renewal _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: R ffo lit_ 1 I) ADDRESS: � Labdia
I, Zot('tio-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
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OWNI ��►
ER/EL I
OR CONTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLO DA, `
COUNTY OF L nd
ACKNOWLEDGED BEFORE ME THIS �AY OF N)CWj13er ,20
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BY taml WHO IS PERSONALLY KNOWN TOME t✓ ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORID o l.�J�
FN
COLEEN SULLIVANMY COMMISSION If GG071535GNATURE OF ARY SE - 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