HomeMy WebLinkAboutPermit renewal 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 !
PERMIT ER: Fz)ADDRESS:
I,. �/►��° ✓ b ,am requesting that the above permit be renewed. I
undifisfand that I mus c edule and pass all required inspections for the permit to be finaled. Further, I1
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection duringany six month period during the renewal period.
Justification
Di Gl c eUr�, ?ew-
CAFit C-0 G*„— p \ �� t�_
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I
OWNE LD -OR TRACT GNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME TMS � DAY OF 20
BY A!?C�C- (�X W[ WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED l/
VA U G H N j
ar° :State of Florida-Notary Public
STATE OF FLORIDA,County of y9 Commission #GG 270079
My Commission Expires
October
SIGNATURE OF NOTARY SEAL
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