HomeMy WebLinkAboutPermit renewal 3 ow+000
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 NUMBER: / JU� ADDRESS:
I, 94 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
'sem
R/BLDR OR C TOR SIGNATURE DATE
i
Print Name
STATE OF FLORIDA
COUNTY OF 5 --�- I_-�
ACKNOWLEDGED BEFORE
(('��ME THIS o�� DAY OF GL.1(� 20
BY �rca� Cck&(-' WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L AS IDENTIFICATION.
STATE OF FLORIDA,County ofL_s,-X C'I.
SIGNATURE-OF S StateELLEr1 t''j
=a®+c Co °f Florida-floral• '
mrnission
fm„a MY Commission Fk/CU7j �
- Octoh� As es_
FOR OFFICE USE ONLY: Ej
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