HomeMy WebLinkAboutPermit RenewalsPLANNING 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 V �� �, , ADDRESS:
_,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 s` month period during the renewal period.
Justification -'Z'A
0 9LUIR "00CONTRACTOR SIGNATURE
Print Name
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DATA
STATE OF FLO
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF
BY ` WHO IS PERSONALLY KNOWN TO ME OR
HAS PR VIDED AS IDENTIFICATION.
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S N OF NOTARY�I
.......
: LASHAHNAINGRAM-RAHMING
:* MY COMMISSION # GG 275060
________ _ ______ ____________ `", 'o`•'_ EXPIRES• December?O,p _
FOR OFFICE USE ONLY: Bonded ThmPintn-Publl�Underwrile•z
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