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 �E�ENED
AUG 272018
PERMIT RENEWAL REQUEST Perms
St Lu Q Co my ent
PERMIT NUMBER:1404- ADDRESS: IoZ(.oyC''Mr) bm
I,.I r) S - '�;C/ll[,`Q ,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 durin renewal period.
stification 0 us'I-Or rer IL
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eng
O NER/BL -&tONTRhtTOR SIGNATURE DATE
rint Name
STATE OF F .O HIDA
COUNTY OF CJI
ACKNOWLEDGED BEFORE ME THIS A l .BAY OF wr-t ,20A_ipi_
BY b e C 1I J WHO IS PERSONALLY KNOWN TO ME_L`_,OR
HAS PROVIDED f 1 Q AS IDENTIFICATION.
rTI
TE O FLORIDA,Co ty of
I _ :e`•'•y COLEEN SULLIVAN
•- MY COMMISSION#GG071535
SIGNATURE OF NOT-AR-Y� SEAL EXPIRES February 09.2021
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