HomeMy WebLinkAboutPermit Renewal _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34M
(772)462-1553 Fax(771)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: l O 0,50 ADDRESS: ��UT �G1L-r{o A > V Q
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 � J2'( R reg
v
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
Pl:- TE2
not Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE uE THIS 30 DAY OF Nd 20_,LL
BY &ter WHO IS PERSONALLY KNOWN TOME____,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of s 1�- L.1.�•�
//0 `;,�+•P�e,, HEATHER BURFORD
i;:state of Florida-Notary Public
SIGN OF NOTARY SEAL =y Commission ;k CO 183217
iy
My CommissionE
February pg 202Zres
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