HomeMy WebLinkAboutPermit Renewal � „ i .�1
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY ,t BUILDING AND CODE REGULATIONS DIVISION.
F I. 0 K I D A 2300 VIRGINIA AVE
IINIIINIIIIIIIMIMIMIIIMIIIIINP FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUESTpeDFC ?OJg
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PERMIT NUMBER:_E�� l�O&( ADDRESS: j J 2O ®rCk k/ Ii -
am requesting that the above permit be renewed. I
under tand that must schedu e 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 eriod.
Justification .---Prvk\/ u0a —1-00 e le:)c) thrl 1
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P3—\--"ICONTRACTOIZ -2 -2®i `'��RIBLDR OR SIGNATURE DATE
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Print Name
STATE OF FLORIDA
COUNTY OF L(C I C
ACKNOWLEDGED BEFORE ME THIS 2— DAY OF 0-e C ,20 Lc
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BY WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED Ft— DC__ AS IDENTIFICATION.
S7- LC.) C/J'
STATE OF FLORIDA,County of " "'�� ELLEN VA U G H N
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(Jou =e`�ili:.c:: of FEiNon AGUGG2y Public
_�� •c Commission � GG 270079
S ATURE OF NOTARY ' ; ,,a�°c My Commission Ex ires
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""""�, October 22, 2022
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
1 Percentage: 1
P
Original permit fee: x%open = $ Renewal fee I
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014