HomeMy WebLinkAboutPermit renewal 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: CJ'`D5-0 ADDRESS: 4
I, PI!L, `jam-of/- .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 inspectio during/any six month period nduring the renewal period.
Justification ���-d D Qa rac ;1 Nt c u)A;v\
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OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLORID
COUNTY OF Laic,
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
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BYV (� �" WHO IS PERSONALLY KNOWN TO ME r—Iniz`"
HAS PROVIDED PC" M, AS IDENTIFICATION.
STATE OF FLORIDA,County of � vim "
� n tiPa'JP'�8,, ELLEN VAUGHN
�r w `-:Commission
of Florida-Notary Public
SIGNATURE OF NOTARY ra Commission #GG 270079
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22, 2621
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
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