HomeMy WebLinkAboutPermit Renewal scrc Fol
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PLANNING'ANDDEVELOPMENT',SERVICES BEPARTMENT.One J. .
BUILDIN..,G AND CODE REGULATIONS DIVISION;
r 2300 VIRGINIA.AVE
FORT`PIERCE,FL34982
(772)462 1553 F,.ax(772)462 1578
PERMIT RENEWAIl REQTEST`
PERMIT .: . V=
NM ..ir
1 45 �1AY1G� .,: ESL atn requesting that the above'permltbe reviewed' I
understand that I must sc'edule and pass all requited Inspecttons for the permit to tie finaled Further•,`t
understand that this is a ONE TIME RENEWAL_arld the,permit shall.expire should Lnot eteive.a
lassug Inspection dunng any six month period during the:"renewal period.
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Q ,_:_-_ LDR'OR`CQNTRACTOR,SIGIVATURE :U_TE
Pnnt.Narne
STATE OF FLORID ... -
CO IJ TY OF .
ACKNOWLEDGED BEFORE-ME THISaz�A— DAY-OF � 1 �` .- 20
BY +� r►` j<<'j' dr _ WHO IS`_PERSONALTY,:KNQWINTO;ME 0R
HAS'PROVIDE]5 rloLo'A AS-IDENTIFICATION..
STATE.,- FLORIDA ,6urIty of.';th&ayN'
�V �: Notary Pubft Stew 0 Florida.
_GNA OF NOTARY Staci 0iltL:
My CcMMIWon I3d 952289
a'I Expites 01129/T024
F-OR OFFICE 17SEONLY:. .
Number iif.Open,In' ecdons
Total.ThsOctions,
(Divide,,open by total to,get-/;of ope"n inspections);
Percentage:,
Original permit:fee x%-:open. enewalfee
Example:. [15:..-divid'ed by 23=.65(%)] $175(pexmit:fee)x 6'S=$113:75.(renewal,fee);
Revised'=7/21/2014