HomeMy WebLinkAboutMisc Letters (2) PLANNING 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
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PERMIT NUMBER: �G l l" �� ADDRESS SSI
I, am requesting that the above permit be renewed. I
understand that I must sche le 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 COe9 a- 1 C
�',5- --p L)
OWNER/BLDR OR CONTRACTOR ATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF Awxx-�,
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 '
BY 10/PQ WHO IS P ONALLY KNOWN TO ME OR
HAS PROVIDED JA `"' a AS IDENTIFICATION.
STATE OF RIDA,County of
C4� 0, N&�ON
SIGNATURE OF NOTAPO SEAL
FOR OFFICE USE ONLY ���
pUDREY 8.NUMP4iREY
'= Y' - Y C0MM1SSlON it Go 300a17
Number of Open Inspections: *_ M 0.7.3
Total Inspections: EXPIRES:March 6:
u *:EOF F�q� Bohru N�un"'.::isevmtors
(Divide open by total to get /o of open inspections) ~' nded T
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