HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST MAY 2 0 2019
ST. Leeie Esuntyi Permittin
PERMIT NUMBER: `�1 �d 3 5 ADDRESS: /(Py �J d .(�n S�lf �[f
I, S� 04-e ` u l rllw ,am requesting that the above permit be renewed. I
understand that I must scheduYe 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 JJ us-f had '41yl e Io 0& 2'-Jck,
12A01-j AAM, S-
OWNWALDR.ORc6NTRAjtTOR SIGNATURE DIATE
'�AOfi--P
Print Name
STATE OF FLORIDA
COUNTY OF 15 V ,b--Q e e
ACKNOWLEDGED BEFORE ME THIS DAY OF Tf%" 20,
BY 'S hNd n� In J1 11 -4,.A WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �' D L- AS IDENTIFICATION.
STATE OF FLORIDA,County ofS-� L O Q « °�'':
:o• r DEANNAMARIE G1Vt,Ns
Ml'COMMISSION#GG 072023 !
EXPIRES:December 16,2020 i z
Ronde
SIGNATURE OF NOTAR §j4}qLfJotzrypublic Underwriters 11
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