HomeMy WebLinkAboutpermit renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- - BUILDING AND CODE REGULATIONS DIVISION
Me . _ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ! �U�'' 0 *�aJ ADDRESS: e;)132- / 1 i 7R-,e,j
1, 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 C90, a'r �
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORID
COUNTY OF 6 - :
ACKNOWLEDGED BEFORE ME TMS J6 DAY OF^/15C?�v L .20-Z
BY OS 1�1 WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OFFLORIDA,County of � Z 8�p� !p lan�ge�
soja x3 uoissiwwoO AN
L t ZE8 t 90 N uoissiwwoo :.
SIGNATURE OF NOTARY SEAL oilgnd AiSION-161PIN3;o alai �
0W03Hf)8 Id3HIV3H
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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 7/212014