HomeMy WebLinkAboutPermit Renewals 04/09/2019 13:21 7726921094 PREMIER PAGE 02/03
tr n>., sty=. PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
. . . BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
- FORT PIERCE,FL 349$2
(772)462-1553 Fax(772)462-1L5_rsTA
IVED
PERMIT RENEWAL REQ9 �G?9
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PERMIT NUMBER: - � ADDRESS: IJV 1 �IF
I,`NY j�'e('YIl e( I QM n Auld • N f ,am requesting that the above permit be renewed. I
understand that I must schedule acid pass all required luspections for the permit-to be finaled. Fuxther,I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection dyr/ng six month period d he renewal period...
Justification �/
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OWNER/BLDR Q$CONTRACTOR SIGNATURE DATE
Kim ;&A
Print NameAPRI6BRUiW
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Comm168pnI GG 208194
�. bpirosApffl V.2022
...di�?� 866dcdZhN7►y1��161nax�ttre3�}384'•
STATE OF FLORIDA
COUNTY OF fna m r)
ACKNOWLEDGED BEFORE ME THIS�A_DAY OF /` 20J-9-
BY
0J7BY WHO IS PERSONALLY KNOWN TO NM of ,OR
HAS PROVIDED AS IDENT'IF'ICATION.
STATE OF FLORIDA,Co ty of m ar T1 r)
9f&XtTE OF LVOT SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total-Inspections:
(Divide open by total to get%of open inspections)
Pexcentage:
Original permit fee: x%open = $ Renewal fee
Example: (15 divided by 23=.65(°/6)] $175(pennit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014