HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
J - BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: �41LNJ'113� `. ADDRESS: I PQ -
i, n15 Zot('e� , 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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>iIR OR CONTRACTOR SIGNATURE DATE
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Print Name
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STATE OF FLO��'RI,D %�
COUNTY OF h
ACKNOWLEDGED BEFORE ME THIS AY OF N)ChA?M)Zff —'20-1&
BY n�,S WHO IS PERSONALLY KNOWN TOME T✓ ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORID o f S�. W�l _
E, E
COLEEN SULLIVAN
COMMISSION#GG071535GNATURE OF ARY SEAIXPIRES February pg 202 t
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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