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:�/ �[� ��� �ADDRESS:
I, , 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
O RB OR CONTRAC OR SIGNATURE DATE
1111,
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STATE OF FLORIDA
COUNTY OF S k L o W`(-
ACKNOWLEDGED BEFORE ME THIS2
_DAY OF FP,h 20
1
BY —eJM WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED „ AS IDENTIFICATION.
STATE OF YLORIDA,County ofYP'�% HEATHER B U R F O R D
lP UB��
State of Florida-Notary Public
=* �_ Commission ft GG 183217
SIGNA OFN TARY SEAL :Illy, F�"��' My Commission Expires
��� � ` February 06, 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