HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
o - BUILDING AND CODE REGULATIONS DIVISION
o .• 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: l J N — CS S ADDRESS: ,� ( �'�Oi u
I, L am requesting that the above permit be renewed. I
understand MY Fffiust 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 A&UY L Ca
OWNER/BL OR CONTRACTOR SI A RE DATE
,-
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE
]�MEE THIS��DAY OF ,2oGSb
BY T l HjQ WHO ISONALLY KNOWN TO ME ,OR
HAS VIDED �r. )c. AS IDENTIFICATION.
i
STATE OF FLORIDA,County of
SIGNA OF ARY SEAL
.`"gyp"•.
AUDREY B.HUMPHR
--------------------------------------------- ---------------------------------------
EY
FOR OFFICE USE ONLY:
*_ MY COMMISSION#GG 300817
9,• Q4: EXPIRES:March 6,2023
'•.FOF F�°•' Bonded Thru Notary Public Underwriters
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