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
I
PERMIT NUMBER: I aN. NUP ADDRESS:
I, ,C v>!r./l/ am requesting that the above permit be renewed. I
under tand 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 W" /' " r rnr 7� tea"'
O D OR CONTRACTOR SIGNATURE DATE/
/
se
I tint Na e
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF IwV 20��
B� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
ST TE OF FLORIDA,County of S" " A .
\91GRATURE OP NOTARY SEAL
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) LASHR state 31 Florida
�Pu''�•. Pl1UI1C' 20'i8
`2et� *�,c,, Notary POPjfes Dec 20,
Revised 7/21/2014 4 * :My com .sion�FF 1772`lAss".
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