HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT m,
a BUILDING ANWCODE REGULATIONS
DIVISION`-
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
- ;.,. (772)462-1553 Fax(772)462-1579
1 S 201
PERMIT RENEWAL REQUEST F:R:ECEIVED:
,%Ant?, f'e� ng
PERMIT NUMBER:, ]f)a ADDRESS: �l(� (-� ��•
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
understand3l of 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 re wal period. ,
Jus ification
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S
ER/B R .ONTRA TOR SIGNATURE DATE
Pot Name '
STATE OF FLORIDA
COUNTY OF,5X. 1� Q
ACKNOWLEDGED BEFORE ME THIS��DAY OFM0,1Zr ,20A._
BY ` ti WHO IS PERSONALLY KNOWN TO ME OR
-
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RA5 PRV1DED AS IDENTIFICATION.
O D Co t •of _
COLEEN SULLIVAN `
MY COMMISSION N GG071535
S! O -AmSE A'; � EXPIRES Febniery 08,2021
:., FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open bytotal to get%of open inspections)
Percentage:
Original permit fee: x%open-.!-- $ Renewal fee
Example: [15 divided by 21+;65(%)] $175(permit fee)x.65-SI b.75(renewal fee)
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