HomeMy WebLinkAboutMisc Letter PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
{�„•� i_.j�r%` s=-tom �!
• BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERNUT RENEWAL REQUEST
PERMIT NUMBER: / Op� JV ADDRESS:
i, 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 MIE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
O ERBLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA ro `
COUNTY OF �9i"• ,
ACKNOWLEDGED BEFORE ME THIS DAY OF v ,20&L—
� m<
�-yl� �^�I a x�c
BY ' • (�I Z WHO IS PERSONALLY KNOWN TO ME ,OR mO 9
o 9?6
HAS PROVIDED �' �r AS IDENTIFICATION. w z c
STATE OF ORIDA,County of - c
9
s a-mC
cD�
iD N
Y
(:Z-
SIGNATTIkE OF NOTAPY SEAL
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