HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
'� 1! 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVE®
PERMIT RENEWAL REQUE T FEB. 4 4 2019
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PERMIT NUMBER: SLC %?Ozl-d3 oZ ADDRESS: 17 N41�e-941 tqv- �I�+✓s�✓ Q r� c�
am requesting that the above permit be renewed. I
understand that I must sche le 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. cGvc. 4-D l � r-� 6 i��,, e;,/e�a liv tea( �,✓ 'v-C') �d r re-
y
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OWNS R SI URE DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 1 DAY OF \�� 2011
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L AS IDENTIFICATION.
STATE OF FLORIDA,County of
"'vv• DEANNA MARIE GIVENS
NIY CaMMISSION#GG 022023
SIGNATURE OF NOT Y =*i Ems:December 16,2020
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Bonded ThruNotary public Undanuritets
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(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014