HomeMy WebLinkAboutrenewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
BUILDING AND CODE REGULATIONS DIVISION
t+il 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER:� A I ��83- ADDRESS: SIS, -
1, �Dpnnis " mr P_K, -,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.
JustificationGJ6I t MD C tib& be '11 "A5 _ int�ao tl�
a"d Anc?-1• "y vi AAS -
49 M 14 1
OWN _CONT ACTOR SIGNATURE ATE
Pant Name
STATE OF FLORIDA
COUNTY OF.tAk, ( jo P_
ACKNOWLEDGED BEFORE ME THIS DAY OF � 1 '20 t 1
BYTP1)d1,SL&L..0 k4.- WHO IS PERSONALLY KNOWN TO ME �,OR
HAS PROVIDED AS IDENTIFICATION.
T D ou . V ,�►"" COloEEN SULLIVAN
MY COMMISSION#GG071535
EXPIRES February 09,2021
Sl A A SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get o of open inspections)
Percentage:
Original permit fee: x%open = S Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=5113.75(renewal fee)
Revised W21/2014