HomeMy WebLinkAboutRenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462^1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: -1--9—' bC ( ADDRESS: I- `1O (.0l er
1, k e�tcj( ) ( i �-, am rPmiPctinorthat the ahnvp nprmit hP rpnpwpr1 i
understand that I must sched a 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
OWNER/BLDR QR CONTRACTOR SIGNATURE
Lr Q
Print Name I V11 V*
5 Z 1
DATE
STATE OF FLORIDA
COUNTY OF
� m
ACKNOWLEDGED BEFORE ME THIS 0 ( DAY OF / / �C1A1�— 7000
BY / i (a5� � WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED l� L,IJ 1�— AS IDENTIFICATION.
ST OF FLORIDA, Coun �of I/ Cf
� SHRRA WALKER
j Notary Public • Sate at Florida
SIG OF NOTARY SEALPER d%i Commission M GG 27201
My Comm. Erpkes Nov 16, 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)
Revind 7/2112014