HomeMy WebLinkAboutPermit Renewals 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: -NVJ 1 ADDRES S:,2�,`i {\ci- Vac- '}-Ti ucz, 4T89
I,1 (a �o 2,aCe_Y-\ -,am requesting that the,above permit be renewed. I
un erstand 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 (,),\an
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LDR GfR CQATRACt-OR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF 51�.Lu CLQ
ACKNOWLEDGED BEFORE ME THIS DAY OF(�f_ � ,20
BY �� C�k WHO IS PERSONALLY KNOWN TO ME��OR
HAS PROVIDED AS IDENTIFICATION.
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SI T SEAL
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