HomeMy WebLinkAboutPermit renewal, updated application All APPLICABLE IN O MLIF BE COP
LETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:ITT-
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Building Permit Applicatiofr�;,�9
Planning and Development Services <oe; oep
Building and Code Regulation Division e�o� 'r
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: "'Pyv w
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Property Tax ID#: 3Cot No._ _
Site Plan Name: -504- 00c�-Q•06cS Block No.
Project-Name:
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aETAIrED17ESCRIPTION WORK
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing —Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 1 ®� Sq. Ft.of First Floor:
Cost of Construction:$ Orb Utilities: —Sewer _Septic Building Height:
fJ]A/NER/LESSEE; rig s�r r, �: F} C9141,AC T.9
Name ^4r^(D Name:
Address: 1 Company:
City: ela4u(2. State Z� Address?.
Zip Code: Fax: City,: `�'' :r, - - ' - State:
Phone No. Zip Code: `_ '�''f' ;7 ;Fax: "
E-Mail: Phbne4N6 V —
Fill in fee simple Title Holder on next page(if different E-Mail T
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is'required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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_ 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: ( l LJ�_O lJ5 r DRESS:
I, � ��� am requesting that the above permit be renewed. I
understand that 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� �'L ,, U
L OR CONTRACTOR SIGNATURE D T
Prin ame
STATE OF FLORID
COUNTY OF
ACKNOWLEDDG�ED BEFORE ME THIS DAY OF -ICLk) 20�
BY '�T ( \�J_�S PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED �� V/ L' AS IDENTIFICATION.
STATE OF ORIDA,County of
ELLEN VAU.GHN
State of Florida-Notary Public
Commission # GG 270079
SIGNATURE OF NOT SEAL '';�0,�����' My Commission Expires
October 22_2022
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