HomeMy WebLinkAboutRenewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
5 Y - BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
P NUMBER: e1 0R-0 3� ADDRESS: IBJ I_Ql�l'G2y1 C-A)rW l in q G�
Ff ��,cc, F L 314941
I, f c n� 1 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.
Justification01-4A
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OVRMMBLDR OR CONTRACTOR SIGNATURE DATE
�
Print Name
STATE OF FLORIDA
COUNTY OF S-t, L V O
ACKNOWLEDGED BEFORE ME THIS DAYOF ,20 2�
BY � +1 A fb C.N),ej(, WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED �:-')C_, AS IDENTIFICATION.
STATE OF FLORIDA,County of
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IGNATURE OF NOTASEAL
FOR OFFICE USE ONLY: a,E.'
LU m EvU_
Number of Open Inspections: Z z o g
Total Inspections: "'
,,W i f,,,
(Divide open by total to get%of open inspections)
Percentage: ro�;
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014