HomeMy WebLinkAboutPermit RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
• BUILDING AND CODE REGULATIONS DIVISION
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2306 VIRGMk AVE
FORT PIERCE, FL 33982
e (772) X162-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT R13MBRR: 11 �P r V ADDRESS: C n �L-cr
1 � � —Cf C C) , , 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 i 6-cr , � c4.1`.ec ; d,
OWNFR BI,DROR CON -TRACTOR SIGNATURE
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Print Name
STATE OF FLORIDA
COUNTY OF
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DATE
ACKNOWLEDGED 1BEFO lE THIS DAY OF .2090
BY j L /ytii .p✓ I3 PERSONALLY KNOWN TO OR
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HAS PROVIDED AS 1,-"' A
STATE OF FLOIWA, Count}- of �✓ ilS
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SIGNATORE OF NOTARY
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Dis-ide open by total to act % of open inspections)
Percentage:
Original permit fee: x % open V $ Renewal fee
Example: i 15 diiided by .23=.65C/0)] S175(permit fee) x.65=$113.75 (renewal fee)
Revised 7,21 2014
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