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HomeMy WebLinkAboutPermit Renewal • • ammenommili PLANNING AND DEVELOPMENT SERVICES DEPARTMENT -S- 400 14ek,-c`` BUILDING AND CODE REGULATIONS DIVISION COUNTY F L O R I D A -- " 2300 VIRGINIA AVE ' 111.1111111.111.11.11.11. FORT PIERCE,FL34982 (772)462-1553 Fax(771)462-1578 • RFCFl1/$O • • PERMIT RENEWALREQUEST AerD£C 2rf?©19 Stu 9�ePart �j /' c01,06 ent PE NUMBER /7 (1 -0(::,..3.5f ADDRESS: / t j/1 fey el - I, 1 12:rA4tAi ,am requesting that the above permit be renewed. I understand at I must schule 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 * NU&Pd- Fl,=-01 Ti SpE LTron! ONLY • 2S2 0/ OWNER/BLDR OR CONTRACTOR SIGNATURE D TE • Print Name STATE OF FLORIDA COUNTY OF St[ k C(� ACKNOWLEDGED BEFORE ME THIS ?.D DAY OF De Com_ 20 BY PG A x L \(c. WHO IS PERSONALLY KNOWN TOME ,OR HAS PROVIDED AS IDENTIFICATION. • STATE OF FLORIDA,County of 3)- ( tel ELLEN N VAUGHN SIGNATURE OF NOTARY . • • SEAL ?; k W_State of Florida-Notary public re Commission#GG 270079 • My Commission Expire • - ,..-. ... October 22 2,022 s • 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(perrnit fee)x.65=$113.75(renewal fee) • • Revised 7/21/2014 • • 1