HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: I 1y I qCJ ADDRESS: )
i, J1n15 z2c to-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
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STATE OF FLORID
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ACKNOWLEDGED BEFORE ME THIS '�AY OF 20
BY nlWHO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORID 1 o U0 •; COLEEN SULLIVAN I
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n MY COMMISSION#GG071535
GNATURE OF '",'i Y'e EXPIRES February 09.2021
�Y 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