HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 q�
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
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PERMIT NUMBEdins J 15 ADDRESS:
I, �enniS Zoe'e 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
WA;b C& 1I 1
O"ER/BLLW OR CONTRACTOR SIGNATURE 15ATE
Do-%5 ZaceK
Print Name
STATE OF FLORID
COUNTY OF 5}.lV e nd
ACKNOWLEDGED BEFORE ME THIS �AY OF t (M 20_iz_
BY n� WHO IS PERSONALLY KNOWN TOME k,� ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORID , o f st, WCAl
COL
SULLIVAN 3
"_- MY COMMISSION#GG071535
GNATURE OF ARY SE '.?o; ` E=XPIRES February 0g,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