HomeMy WebLinkAboutpermit renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
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PERMIT NUMBER: ADDRESS:
I, ;/Y1iC.�/14°�-f'J1 A am requesting that the above permit be renewed. I
and sre and 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
14.
O RIBLDR OR CONTRACTOR SIGNATURE DATE
Prue
STATE OF FLORIDA
COUNTY OF 4e— 4AJL4-t_
ACKNOWLEDGED BEFORE ME THIS�1DAY OF affin/ 20
BY M`.Gtvy$t'U_ r�PSL, c� WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED 'J C i AS IDENTIFICATION.
STATE OF FLORIDA,County of HEATHER BURFORD
_State of Florida-Notary Public
=` Commission 0 GG 183217
SIGN TURE O NOTARY SEAL ,4 0, 0, My Commission Expires
February 08, 2022
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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