HomeMy WebLinkAboutPermit Renewals .I y �`
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
m �'n7 6Q
BUILDING AND CODE REGULATIONS DIVISION.
2300 VIRGINIA AVE
w w FORT PIERCE,FL 34982 r
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: -G 11 I ADDRESS: i
I, 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
S• t
R OR CONTRACTOR SIGNATURE 1DAtE
Print Name
I .
STATE OF FLORIDA
COUNTY OF '9 L4 (
ACKNOWLEDGED BEFORE ME THIS I Sk DAY OF Wa i(C k 20_L9
BY(Tr ^1rtd K 111AA,rw e� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED Pa LIC_msL Mo 1-1 1 4S 101 AS IDENTIFICATION.
STATE OF FLORIDA,County of SA U C lSL �'" TIFFANY J GA EA
' MY C016 JISSIpN 0 FF904585
SIG F NO ARY SEAL
EXPIRES 30,2019
NC7139b-0�g3
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)
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Revised 7/21/2014