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HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT IN'-:la'1�t I BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578 PERMIT RENEWAL REQUEST PERMIT NUMBER: l ©ADDRESS: I St S • r OVi Lk U VI ,am requesting that the above permit be renewed. I understand that I niust 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 FrloT- j e f mac-clto tA 0;�-o OWNE LDR OR CONTRACTOR SIGNATURE DATE k� . um Print Name STATE OF FLORIDA COUNTY OF S k. Q-' ACKNOWLEDGED BEFORE ME THIS 'D DAY OF \1 26 a0 BY JA WHO IS PERSONALLY KNOWN TO ME OR HAS PROVIDED 1D AS IDENTIFICATION. TATE OF FLORIDA,County of "�1"�,'•• {�9YCOMIAISSION#CGQ�,02" j _• ►RES:0 ttlbet'•i6,20Ma � SIGNATURE OF NOTj11Y '��,' _= ndadTl�N ad Nok+tyPublicUndanvrde s .........Pgo 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