HomeMy WebLinkAboutPermit Renewal Df (Z°(2
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY BUILDING AND CODE REGULATIONS DIVISION
FLORIDA 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST FEB 22
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PERMIT NUMBER: 1 6 C J v 93 C ADDRESS: "I\. 5 3 3 4-
I, o ( k'visv d -cc 5 ,am requesting that the above permit be renewed. I
understand that I munt 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 "" :W �1 ``D G ( J 1- .pea i
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0ER/BLDR OR CONT TOR SIGNATURE DATE
Print Name
STATE OF FLORID Cbc
COUNTY OF
ACKNOWLEDGED BEFORE ME THISI a 27 DAY OF �, ,20 19
BY NO'(��Cl� 1`� R p(}l J`�� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED , PL AS IDENTIFICATION.
LLEN
STATE OF FLORIDA,County of 5 1. U_�-e— .""�P��,
VAUGHNPublic
u *°y„_� 'State of Florida-Notary
SIGNA of NO� SEAL i Pac Commission #GG 270079
%,0,71Tp` MY Commission Ex •
October 22, 2022ires
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