HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
.� • BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 kFCFl
(772)462-1553 Fax(772)462-1578 Nov `FO
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: l W✓O ADDRESS:
i, nIS ZOt('t°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
1,
OWNER/BLFV OR CONTRACTOR SIGNATURE DATE
finis MUK
Print Name
STATE OF FLORIDA, `
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS��AY OF 20_[B_
BY � II��r �WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED 1 , 1 AS IDENTIFICATION.
�-� LUUE' +�`" COLEEN SULLIVAN I
S OF FLORID Aof MY COMMISSION#GG071535
EXPIRES February 09,2021
%NATURE OF SEAL
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