HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 �FCF
(772)462-1553 Fax(772)462-1578 0 *O` r�'crC;
PERMIT RENEWAL REQUEST `G�9c d Ile
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PERMIT NUMBER: ADDRESS: `tel 92C) QDMCLjL) LQ 1 f PiaCe
I, n15 Zat('eK , 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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OWNERIBLUR OR CONTRACTOR SIGNATURE DATE
D°%5 ZQCeK
Print Name
STATE OF FLOR DAA
COUNTY OF L I
ACKNOWLEDGED BEFORE ME THIS S: nAY OF ,20_t&
BY �n��aWHO IS PERSONALLY KNOWN TOME f✓ ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORID 1 o UCIl
►""' COLEEN SULLIVAN
MY COMMISSION#GG071535'
' EXPIRES February 09.2021
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-SIGNATURE OF ARY SEAL ''��°',�
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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