HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
" BUILDING AND CODE REGULATIONS DIVISION
* 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: I Sly'0IQ3 ADDRESS:PS) &I fta 14 AV,
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
ER/BLDR OR CONTRACTOR SIGNATURE I5ATE
Print Name
STATE OF FLO ,
COUNTY OF /Q
ACKNOWLEDGED BEFORE ME THIS DAY OF ,20 / 1
BY U WHO IS PERSONALLY KNOWN TO ME 'I OR
HAS PR VIDED AS IDENTIFICATION.
ST OF FLORIDA,County ofa
SIGNATURE OF NOTARY , SEAL
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 7/21/2014
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