HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
- 2300 VIRGINIA AVE
FORT PIERCE,FL 3082
(772)462-1553 Fax(772)462-1578
PERMIT RENEWALREQUEST .
PERMIT NUMBER: VADDRESS: G4—
^ � J
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 O' o UA 1•
-7 'A
OWNERBLDR OR CONTRACTOR SIGNATURE I)AtE
Print Name
STATE OF FLOC _ ,
COUNTY OF " ►C�tL
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY WHO IS PERSONALLY KNOWN TOME .OR
HAS PROVIDED �1>�� AS IDENTIFICATION.
OF RIDA,Coun of •�' � o
GN OF NOTARY QS SEA1
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
i `.SARA p
Percentage: .�o `'i"1 LASHAHNA INGR
Original permit fee: x%.open = $ Renewal fee ublic
$* ;°= Notary p - AM
-'_'o *.; State of Florida
y Comm.Expires Dec
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal f 07 Flo?.••' Commission#FF 177299 1B
Bonded through National Notary Assn.
Revised 7/212014 .�'