HomeMy WebLinkAboutPermit Renewals JAN-24-2019 THU 08 37 AM CENTRAL SCHEDULING FAX No. 3212686138 P, 002
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
a ~1 BUILDING AND CODE REGULATIONS DIVISION
• - 2300 VIRGINLA AVE
- - — - FORT PIERCE,FL 34982
(772)462-1553 Fox(772)462-1578
PERNUT RENEWAL REQUEST
PE IT NUMBER 1_ zi ,A,DDRESS: 'A Caff uNIP—/
1, ttMaic-A1e ,am requesting that the above pem-dt be renewed. I
understand that I must schedule and pass all required inspections for the pennit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing insp 'on during ally six month period dvidug the renewal period.
Justific tion
4CQ t
OWNERIBLD,RIO CONTRACTOR SIGNATURE DATE
� �-• pati c.��� . � _
Print Name
STATE OF FLORIp�.'
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF Qnc 201
BY WHO IS PERSONALLY KNOWN TO ME OR
-HAS PROVIDED � � AS IDENTIFICATION.
STA7,OF PL RIDA,Countyof CATHERINE MILLER
State of Florida-Notary Pubiie
=� *c Commission#GG 273315
ExpiSIGNATOF OTARY s.,�������.'' MY Commission 2022 a
URE N
November 01,2022
FOR OFFICE USE ONLY:
Number of Open Inspuctions=
Total Inspections:
(Divide open by total to get%of open inspections)
Peircentage:
Original permit fee: x%open = $ Renewal:fee
Example: [I5 divided by 23=.65(%)] $175(pem; t fee)x.65^$113.75(renewal fe )
Revised 7/21/2014 RECE
ED
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