HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
IT.7R
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: Irl
V"I:rV Ut ADDRESS: 3 12-0
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 durin any six month period during the renewal period.
Justification 0-�N iNAIIA,10/1 lca+164
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O R/BLDR OR CUNTRACTOR SIGNATURE DATE
rint Name
STATE OF FLORI
COUNTY OF
ACKNOWLEDGED HIS DAY OF O l 1 20
BY 0_3 WHO IS PERSONALLY KNOWN TO ME —`,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of v +++�����, ELLEN VP,U G H N
IFFY aVB�i
State of Florida-Notary Public
Commission #GG 270079
SIGNATURE OF NOTAAY SE My Commission Expires
October 22. 2022 .
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