HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
- FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMITNUMBER: � �� ADDRESS: �'.pQd/6
I, W,dIAN 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 inspec 'on during an six month period during the renewal period.
Justification
3 � .
OWNE LDR OR CONTRACTOR SIGN DATE
Aylen
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS��AY OF C) CJ 120
BY �Qp���� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED �� 0� AS IDENTIFICATION.
STATE F FLORIDA,County of V
APPY PV9
ELLEN VAUGHN
State of Florida-Notary
SIGNA OF NOTARY �; com/mYission # GG 2707,9
Corn Public
mrsslon Exire
'
October 22, 202Z1
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