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
PERMIT NUMBER: �V v b5 q ADDRESS: = `
I, �'11(�t 1 A- Kt C I 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 1,
0WNEk/B1,DR OR CONTRACTOR
`SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF 61t_ 4.1
ACKNOWLEDGED BEFORE ME THIS-3 DAY OF 20_9__
BY rn,C lj fteiC- re-(V C,�,,J(, //WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �y AS IDENTIFICATION.
STAT OF FLORIDA,County of
�.wrr
SI ATURE'OFNOTA VV SEAL .;►Ay'P;,'%, HEATHER BURFORD
State of Florida-Notary Public
•= Commission 0 GG 183217
My Commission Expires
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