HomeMy WebLinkAboutPermit Renewal Request PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
' ` +
COUNTY BUILDING AND CODE REGULATIONS DIVISION
��
.e •t a R ,� ,n A _ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: (P ( =-0S a7 ADDRESS: .D:7 01 a I1)Ca\
I, 1\1\\ \Ck f r-i crk}'lk 5 J e) ,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 (rt15 orICAR e \
`6 --y2)ta)
OWNER/BL R OR CONTRACTOR SIGNATURE DATE
Kt, C)'-r-1 V Y") , C�55�1
Print Name
STATE OF -
COUNTY OFFLORIDAV"
ACKNOWLEDGED BEFORE ME THIS 13 DAY OF ,20 19
BY ►\!\doN.)�-i��P Q WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED --VLL D L AS IDENTIFICATION. •
STATE OF FLORIDA,County,of ✓E WI CAL ,�����,� .
``0141,4! ELLEN VAUGHN
:* ui A°6cState of Florida-Notary Public f
A A./ P� Commission # GG 270079
SIGNATURE OF NOTAR '� SEAL ', , ;o�,� My Commission Expires
October 22, 20221,.:
FOR OFFICE USE ONLY:
Number of Open Inspections: ,-/-10
Total Inspections: „."7-
(Divide
(Divide open by total to gpt4'o of open inspections)
Percentage:
Original permit fe . x%open = $ Renewal fee
Example: 15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
' li