HomeMy WebLinkAboutPermit Renewals i
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
DENIM
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT NUMBER:_lZ0 �` cSJ ADDRESS: 57
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7,o�;7U7V ,{,Gv jvy Z ,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 `r(f E y �9-s�T c-�e 5)L�'rr z�-7- TKA
y9�-a� r ft cry
77 / 12 -17- A.2
R/BLDR CONTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _DAY OF� �s 20G
BY (), QA% r '"Onx WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
S TE OF FLORIDA,County of
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(;SIWOFINOTARY LASHAHNAINGRAM-RAHMING
=, W COMMISSION#GG 275080
El0?IRM DoWnbeft,2022
------------------------------------------------------------------- y., :_lienQfldMWMdam _—_
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)
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! Revised 7/21/2014
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