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HomeMy WebLinkAboutMisc Lettersi 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: l/ ©)/I ADDRESS: T o 1 � y � �� 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 OWNE L G DATE Print Name STATE OF FLORIDA _Q� COUNTY OF �` xy e clum ACKNOWLEDGED BEFORE ME THIS_�DAY OF 20 ,�• rN BY ISO) )n / O'I eI^S WHO IS PERSONKNOWN O ME OR m o a E265 Lo a:am HAS PROVIDED AS IDENTIFICATION. u' a 5 CC 2 ZE STATE OF ORIDA,County of m SIGNATURE OF NO AR SEAL :o 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