HomeMy WebLinkAboutPermit renewali
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT I.
COUNTY
R BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: U'1— O a ADDRESS: �CQ G
MAQ ,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
r c- .7-r �
OWNER/BL OR CONTRACTOR SIGNATURE DATE RFCf
Fp
�N Ti�ULI,�
DEC.03101�
Print Name Perm/tt/n9 D
St LUCie count),
STATE OF FLORIDA,,,, �—
COUNTY OF R
ACKNOWLEDGED BEFORE ME THIS DAY OF 20��
BY \'Cl SCQtIly 5 V Uk-5�—WHO IS PERSONALLY KNOWN TO ME OR
(� I
HAS PROVIDED �L �) AS IDENTIFICATION.
STATE OF FLORIDA,County of �� ( ( C![ _� �PYP� ELLEN ' AUGHN_
%u IPublic
`=o�P B`�=State ofi Florida Notary
.= Commission # GG 270079
,y.y®o; My Commission Expires
SIGNATURE OF NOTARY MF,-F 0\V' October 22, 2022 .
i
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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