HomeMy WebLinkAboutPermit Renewal i '
I '
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
1
BUILDING AND CODE REGULATIONS DIVISION
W. 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
,15 £RMITNUMBER: a Z� ADDRESS: rQ vin
61
I, ,am requesting that the above permit be renewed. I
understand that I must sche 1 d pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE ME RENEWAL and the permit shall expire should I not receive a
passing inspecti during any six month period during the renewal period.
Justificatio
OWNERBLD{R Q CTO SIGNATURE DATE
ev? ll �
Pri ame
el,
STATE OF FLORIDA r -�
COUNTY OF
ACKNOWLEDGED BEFORE)ME THIS DAY OF
BY7!f7�.I'�� WHO IS PERSONALLY KNOWN TO ME 7OR'
HAS PROVIDED L AS IDENTIFICATION.
STATE OF FLORID County of
SIGNATURE OF NOTARY SEAL
ELLEN VAUGHN
;State of Florida-Notary Public
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FOR OFFICE USE ONLY: 10F�oP,. My Commission Expires
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