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
PERMIT RENEWAL REQUEST
PERMIT NUMBER: I 1 — 1 I��L ADDRESS: l—ICP (Ft-- Q 0-c 1Ci A-4�
am requesting that the above permit be renewed. I
understand that I must,schedd& 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 OU� o-F Cos),A
0 OR C TRACTOR SIGNATURE DATE
Ol —t�--
Print Name
STATE OF FLORI A
COUNTY OF \ \\
ACKNOWLEDGED BEFORE ME THIS _DAY OF J Ul V 20 ]
BY WHO IS PERSONALLY KNOWN TO ME OR
' HASP VIDED AS IDENTIFICATION.
S TE OF FLORIDAMul
S N OF NOTARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections: . ; LASHAHNAI
' ' AM-RATotal'Inspections: MYCQMMIS MING
SION ,
#GG 275060 f
(Divide open by total to get%of open inspections) =FP S:EXPIRE Decembe
'.aFF��•` Bonded IRE 1Vo r'20,2022
Percentage: Lary Public Underwriters
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