HomeMy WebLinkAboutPermit Renewal (2nd time) PLANNING AND DEVELOPMENT SERVICES DEPARTMENT,
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COUNTY BUILDING AND CODE REGULATIONS DIVISION
:F I. OR 1 b A= 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
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PERMIT NUMBER: VI OOV3 ADDRESS:U-b ' O`a) V-)\D\Q-J \ C\•
I, CN N5 C , 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 sire S 1-0 OVOU) US -VD C U -
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OWNERLDR OR 'INTRACTOR SIGNATURE DAT
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Print Name
STATE OF FLORIDA
COUNTY OF (.5-r LUC
ACKNOWLEDGED BEFORE ME THIS gill-DAY OF 1 ---L ,20 Fi
BY DLII)\( C WHO IS PERSONALLY KNOWN TO ME ✓ ,OR
HAS PROVIDED I 1 IlQ AS IDENTIFICATION.
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FLC ar• 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