HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
sUNTY BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL34982 RECEIVED
(772)462-1553 Fax(7U)462-1578
DEC 1 7 `01�.
PERMIT RENEWAL REQUEST r 6N6Ie Eotaniy,Fermittirk
PERMIT NUMBER:
C�3w ADDRESS: / yD 3 e
I, / //J h 4 am requesting that the above permit be renewed. I
understand that I must ichidul d pass all required inspections for the permit to be finaled.. Further,I
understand that this is a ONE. RENEWAL and the permit shall expire should I not receive a
.passing inspection during any six month period during the renewal period.
Justification all eh
r 170 2
OWNERIBLDR OR CONTRACTO IGNATURE DATE
V 1
Print Name
STATE OF FLORIDA
COUNTYOF
ACKNOWLEDGED BEFORE ME THIS DAY OF p Q C 20
BY J`� V-%S WHO IS PERSONALLY KNOWN TOME__---,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of 6} • l'J C�l
•�;.. DEANNAMANE GIVENS,.
� �•Y my coMMISSION 8 GG 022023
SIGNATURE OF�NOTY ~ w E)1pag�S;December 16,2020
°';s„f,d,.� Bandead 1 n"'tN"a"Public Undotwriters
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 V21014