HomeMy WebLinkAboutPermit RenewalPLANNING 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: 0 9 — 00 G !9 ADDRESS: 1 `1cm "1 L7I3C y S AD • F+. 1"I G`tL''li
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
O R/BLDR OR CONTRACTOR SIGNATURE
7Q u 6� A'S (Zp c
Print Name
6-q-Za
DATE
STATE OF FLOR�A��� ��
COUNTY OF
ACKNOWLEDGED BEFORE THIS U DAY OF _6 vcj�j� 20 20
BY WHO IS PERSONALLY KNOWN TO ME h OR
HAS PROVIDED AS IDENTIFICATION.
STATE
STATE OF FLORIDA. CalJow,
7SIAT�UURE TARP
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
s5°i KEGAN CRAWFORD
MY COMStISSIOS # GG26A�6
,EXPIRES October 03. 2022
Example: [15 divided by 23=.65(%)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 7/21/2014