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HomeMy WebLinkAboutBuilding Permit Application (2) I PLANNING AND DEVELOPMENT SERVICES DEPARTMENT r, BUILDING AND.CODE REGULATIONS DIVISION. 2300 VIRGINIA AVE FORT PIERCE,FL 34982 r T� �1 (772)462-1553 Fas(772)462-1578 1\ �J PERMIT RENEWAL REQUEST PERMIT NUMBER:, ' ©O W 2 ADDRESS: I, (�9,p(Ly J�Crg ti�-L,t�n�,�— ,am requesting that the above permit be renewed. I understand that I must schedulePand 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 - y 9 OR CO CTOR SIGNATURE 15AtE Print Name STATE OF FLORrQA COUNTY OF L V C kJe ACKNOWLEDGED BEFORE ME THIS DAY OF HOL JrO 120_� BY Gf-e%0%:!4 T-1A 6i 11 WHO IS PERSONALLY KNOWN TO ME OR HAS PROVIDED-PA Lt c vnge, Ma . 1 , 14 5-101 AS IDENTIFICATION. TATE OF FL RIDA,Co ty of J'1 L Lam— ;.►"'! TIFFANY J GADEA MY COMMISSION#FF904585 SIGN O NOTARY SEAL ,ql . •• EXPIRES August 30,2019 407)39&0153 F1orldnWota �.�„` 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 I