HomeMy WebLinkAboutPermit Renewal (2) PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST <4,1910
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PERMIT NUMBER: C,1X ADDRESS: (�OX ;') bw6 4� I
I, ZaCto-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
WA;6
OVNERBLIW OR CONTRACTOR SIGNATURE DATE
IEnA15 ZaceK
Print Name
STATE OF FLORID)
COUNTY OF 4W
e �d
ACKNOWLEDGED BEFORE ME THIS �AY OF ,20__[&
WHO IS PERSONALLY KNOWN TOME L,� ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORID of et. UJCAe —� --
GOLEEN SULLIVAN
nil _ n_ MY COMMISSION 4 GC-071535GNATURE OF AR TY SEAL 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