HomeMy WebLinkAboutPermit Renewals i
i
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: C IgII� D��/ ADDRESS:
I, � �� �SIli9Cl'7� ,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
OWNERS DR OR CONTRACTOR SIGNATURE DATE
�W a >
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS�_DAY OF 12 01 9
BY JAQ -tC1�r�� WHO IS PERSON�ALL,Y KNOWN TO ME OR
HAS PROVIDED c}Ii1�.R _ �IIX AS IDENTIFICATION.
S ATE OF FLORIDA, of
' •<��e;'• LASH NAINGRAM-RAHMING
S TURE OF NO Y ;, S MY COMMISSION#GG 275060
o"= EXPIRES:December'%2022
'koFF;°Q`•••BOndwThmNotary Public Undel abm
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