HomeMy WebLinkAboutPermit Renewal ,
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....... PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY
BUILDING AND CODE REGULATIONS DIVISION
R o t o z�. 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RE
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PERMIT RENEWAL REQUEST per
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PERMIT NUMBER: 15OIt VC)� ADDRESS: �� I , .A 10 cD (� o i%I
I, . L 4-A ,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
understandthat 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 . A-(Te, -1- on$ Ic n h crtqcJ P f < ' II
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0 LDR OR CONTRAC OR SIGNATURE DATE
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Print Name
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STATE OF FLORIDA 1
COUNTY OF `) I C
ACKNOWLEDGED BEFORE ME THIS 4,(0 DAY OF fej3 ,20 l 1
BY L Vl Q. Ck -e WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED r L i)L, AS IDENTIFICATION.
STATE 8 FLORIDA,County of 3 11 vvv
1------------ 74p1,;;,: ELLE1 N VAU NSIGNATURE OF '�: Y S e, _. a 4t`State ofFlorida-Nota y pcb;`iif;►a�� Commission #GG27007
ogIA P.' My Commission mission Expires
October 22'2022
FOR OFFICE USE ONLY: it
l 1
Number of Open Inspections: I
Total Inspections:
(Divide open by total to get%of open inspections) ,I
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
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