HomeMy WebLinkAboutPermit Renewals 06/06/2019 09:04 7726921094 PREMIER PAGE 02/03
PILAINNING AND DEVELOPMENT SERVICES DEPARTMENT
3 BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(773)462-1578
PERMT RENEWAL REQUEST
9LC/ 70g6386 DREss: ee-a �n ► [3 7
Len i b(�
e( (� 11 Q(�d r am requesting that the above permit be renewed. I
understand that I must sCbe le and.pass all required inspections for the permit to be fmaled. Fun-ther, l
understand that this is a ONE TE%M A- MMAL,and the permit shall expire should I not receive a
passing-impectioxx d g any six Month period a renewal penod. �+
JustTication S
bk /&
OWNF,F,'131,DRa&CONTRACTOR SIGNATURE. � DATE
Print Name APRU. y
• :.• x-�47� �
' ilpyFa >WaWg`h49�
STATE OFFLORIDA
COUNTY OF Vl+i hr
ACTS.NOWJ..FDGEDBEFORE M£sTk11S • DAY OF
W.He Is ERSONAL,I,X E?ti0 • TO NM ,OR
HAS FFOvmzD _.... AS zDENTWIcaTlorr_
5TA7'E OF FLORIDA,Co ky 0 MrAil� ----
SI a NoT SEAT.
FOR OFFICE USE ONLY:
Nlunber of Open Impections:
Total ImTpecdous:
(Divide open by total to get%of open.inspections)
Percezztage:
Original pormit fee:, x%open = $ _Renewgl feo
BxauTle: [15 divided by 23d.fi5(%)] 175(pezzmt fire)x.65=$113.75(renewal fee)
Revised 7/21/2014