HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RECEIVE®
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
JUL 2 9 299
PERMIT RENEWAL REQUE fir, �uefe County, Permitting
PERMIT NUMBER: ` ADDRESS: '5 1 Z) � _F0S'wa a
I, (jt l-A,-- �6�/��` ,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 �O� — �' �/ �,� �� .� ��,, aW ✓,
OWNER/BLDR OR CONTRACTOR NAT I3ATE
I (CL)2a_ 1N)0c ,26es:4
Print Name
STATE OF FLOR4DA
COUNTY OF 53r-
ACKNOWLEDGED
.-ACKNOWLEDGED BEFORE ME THIS DAY OF 5 J > q 20
BY w'♦1�adv++ti ��`n `� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
DEANNAMARIE GIVENS IF3
MY COMMISSION#G,02202
SIGNATURE OF TARY �,e�,E. lb6�PIru Decambar p6,2rltp ii!
d 7hru Notary pubilc iJT, rtvritar:i
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