HomeMy WebLinkAboutPERMIT RENEWAL REQUEST 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: ADDRESS: U13 S U S 1—
I 1
I, V/cc 4111'l K, pAl f GS ,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 b f V
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
\j�
Print Name
1
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS C� DAY OF C-1,Q&1'.D 20
BY �+_._MQ n� WHO Is PERSONALLY KNOWN TO ME OR
HAS PROVIDED !` AS IDENTIFICATION.
ST TE OF FLORIDA,County of ':�A 1 YC�n
EL :
NA INGRAM-RAHMING
SIGNATURE.OF NOTARY MISSION#GG 275060
S:DeCembets20,2022
e Notary Pub9c Undeswrltets
j 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