HomeMy WebLinkAboutBuilding permit RENEWAL application PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: fAfADDRESS:/1700 f,(JaymPy/� l /r � ��/Ao�
I, � �f�� ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required Inspections for the permit 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 eri d.
Justification d DU 5r l�,��(LGT �' C d Q D N I , VU()I
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OWNER/BLDR 6R ONTRACTOR SIGNATURE DAT
14A49AY r. $&Lf-
Print Name I
STATE OF FLORIDA
COUNTY OF `�—
ACKNOWLEDGED BEFORE ME THIS_�DAY OF V�p ,20_ao
BY tAd\(V'C..1 �`(�_ WHO IS PERSONALLY KNOWN TO ME ,OR
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HAS PROVIDED AS IDENTIFICATION.
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STATE OF FLORIDA,Coun of f'It
b G: ADRIANA i YA
_ �- Notary Public-State of Florida
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Notary
Commission 9 GG 964625
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T OF NOTARY SEAL My Comm.Expires!Nov 7,2023
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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