HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
=-RECEIVED
(772)462-1553 Fax(772)462-1578PERMIT RENEWAL REQU19 volq
PERMIT NUMBER ,69 Lss:
I, L� J am requesting that the above permit be renewed. I
understand tbatff 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
OWNERBLDR OR NT CTOR SIGNATURE D TE
c,�Q
Print Name
STATE OF FLORI
COUNTY OF f f�
ACKNOWLE GED BEFORE ME THIS DAY OF l ,20.
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BY WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,Coun
o�►RY'°°m, Oev-7
SIGNATURE OF NOT SE r Commiss
v� Q Commission
oF�oQ° Bonded Th
Florida
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