HomeMy WebLinkAboutPermit Renewals i
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
a `=
� BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: O 11 v a ADDRESS: 935 f) �7 U L ISS n'1) z n 12 J
I, (JI SC4r C. ,am requesting that the above permit be renewed. I
understand that I must 9chedule 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
,? 11311 i�
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
aQuv) S �w✓ c
Print Name
STATE OF FLO A ,
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS��DAY OF a661A, 20
BY ✓-J'Gt>N ��i�YY`�G S WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STA E OF FLORIDA,County o
at,pr rosy &W M.SPARKS
MY COMMISSION I FF 906220
SIG ATURE OF NOTARY SES * EXPIRES:December 3,2019
"diol*
Bonded DroOW9001y31r" s
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
I
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014