HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
® M-0BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: L03 -C)51 7ADDRESS: t/" ekY- J�� (
I, G -�D .ti`�a�,am requesting that the above permit be renewed. I
understand I rdust 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
3 - '-Z
O LD R TRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA a,
COUNTY OF9141�1
AC LEDGED BEFORE ME THIS c::)l DAY OF w LG '1 20 �
BY Y7 n`WHO IS PERSONA Y KNOWN T ME OR
HA P OED AS IDENTIFICATION.
STATE OF FLORIDA,County of ,
SIGNATCUM OF NOYRY 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