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:- 160 '®q5a ADDRESS:
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I, (� ' �Ct✓�S' l C/ ,am requesting that the above permit be renewed. I
understand tha t 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
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OWNER/BLDR OR ONTRACTOR SIGNATURE DATE
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Print Name
STATE,OF FLORIDA
COUNTY OF {'-
ACKNOWLEDGED BEFORE ME THIS bq aq—DAY OF Fe e 6<-C!2 rr- 20#—
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
ATE OF FLORIDA,County of
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LA%W NWWGRQ-
SI ATURE OFNOTARY SEAL _ Myr�MMlSSlON DWG
e 5060'DeCEMW! 2022
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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