HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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�I e r !: BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGLNIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578'
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ADDRESS:
I, ,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
DR OR CONT C OR SIGNATURE DATE
'14cf/le-el, d,i
Print Na the
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STATE OF FLORID
COUNTY OFF ,t�
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 G
BY /� � ZG:—WHO PERS NAL Y KNOWN TO ,OR
HAS PROVIDED AS IDENTIFICATION.
ATE F FLO A,County of
LIBERTYA.KING
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MY COMMISSION#GG 090638
N TORE OF N7. SEAL :,_ EXPIRES:May 4,2021
Bonded Thru Notary Public Un&m tera
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
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