HomeMy WebLinkAboutPermit Renewal Requesti 4 -
Public Works Department
Code Compliance Division
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
PERMIT RENEWAL REQUEST
ADDRESS: PERMIT NO.: 0 0
I, AM REQUESTING THAT THE ABOVE
PERMIT IS RENEWED FOR EIGHTEEN MONTHS. 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.
Owner/Builder or Contractor Signature Date'
STATE OF FLORIDA
COUNTY OF
Sworn to' and subscribed before me this _day of . 200_
by - Who is personally known or who has produced
as identification.
Notary Public, State of Florida
Signature of Notary:
Commission No.: (Seal)
FOR OFFICE USE ONLY: RENEWAL FEE: .49%
OPEN INSPECTIONS ( a 1 ) X ,PERMIT FEE (S_6360'4 14) = S ��� JAI ' 3
TOTAL INSPECTIONS (35 . )