HomeMy WebLinkAboutpermit renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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J - BUILDING AND CODE REGULATIONS DIVISION
. 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 10,
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PERMIT RENEWAL REQUEST l4cPc oa �O
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PERMIT NUMBER:00, o(0(0 D ADDRESS: I w ;2) Sx- b
i, 1n15 z2c e 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
OWNER/BLUR OR CONTRACTOR SIGNATURE DATE
Diwh15 ZaceK
Print Name
STATE OF FL A, e —
COUNTY OF T �d
ACKNOWLEDGED BEFORE ME THIS �AY OF N)ChMber 20_1&
BY �nWHO IS PERSONALLY KNOWN TOME 1,� ,OR
HAS PROVIDED AS IDENTIFICATION.
%GNATURE
FLORID , o f Gt. ucleall
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,`•'Fv'`-4,, COLEEN SULLIVAN
'c MY COMMISSION#GG071535
OF ARY1
SEAL EXPIRES Februar~�09,20?1
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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