HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
COUNTY ,i
FLORIDA 2300 VIRGINIA AVE
111111111111111111111111111111111111111111111/ FORT PIERCE,FL 34982
• (772)462-1553 Fax(772)462-1578
• PERMIT RENEWAL REQUEST
PERMIT NUMBER: 50110--O07-7 ADDRESS: '7405 1I f CCA it Avis
I, aCe, ,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'' 4-z ce./9v. /
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OWNE���LD O CO RACTOR SIGNATURE DA
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Print Name
STATE OFFLORI -( ,
COUNTY OF lel�i.t •
ACKNOWLEDGED BEFORE ME THIS t.`� DAY OF ,20 t}C)\ •
BY C-e,J f L{103 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE F F ORIDA,C. my of ,3 u�/��
� ^ ELLEN VAUGHN
i 0 ar° i 40_State of Florida-Notary Public
SIGNA RE OF NOTA,'Y SEAL *�~�+- Commission #GG 270079
%;4 11`°e°:' My Commission Expires
October 22, 2022
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(%)1 $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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