HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTYBUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RFC4�v
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: ADDRESS: 3 COO
I, lenl\l5 zgeeK -,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
wAiIo �-r�?lv i ISS
OWNERiBLIN OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORID
COUNTY OF .
ACKNOWLEDGED BEFORE ME THIS rid
OF! MMb(Y, 20
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BY ��� WHO IS PERSONALLY KNOWN TO ME L,-' ,OR
HAS PROVIDED AS IDENTIFICATION.
IGNAT
OF FLORIfoun y f S�. l__�)�1� COLEEN SULLIVAN ,
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2MY COMMISSION#GG071535
URE OF ARY SE L EXPIRES February 09,2021
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 721/2014