HomeMy WebLinkAboutPermit Renewal (1) PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 'P
(772)462-1553 Fax(772)462-1578 $ 'I'O`
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PERMIT RENEWAL REQUEST o`°od
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PERMIT Na,
UMBER: � � atl�, ADDRESS: 1 ,
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I, n15 zac i?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
OWNER/BLIV OR CONTRACTOR SIGNATURE DATE
I ° hl5 MCeK
Print Name
STATE OF FLORID
COUNTY OF �d
ACKNOWLEDGED BEFORE ME THIS f`�''I�AY OF 20
BY Un' ` Z�a� WHO IS PERSONALLY KNOWN TO ME t✓ OR
HAS PROVIDED AS IDENTIFICATION.
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SE MY COMMISSION#GG071535
'•,, , 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(%)] S 175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014