HomeMy WebLinkAboutRenewalPLANNING 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: l t Z " 6371 ADDRESS: jU 0 G�(G f Q,1� Qf = r!A kucc { �� 3*15-
I,�✓�"�� cri 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 inspectionduring any six month period during the renewal period.
Justification
r
cation pef✓►'i,
ERBLDR O CONTRACTOR SIGNATURE
.� �IWrS
Print Name
A q /,-) 0 _
DATE
STATE OF FLORIDA
COUNTY OF 5T Lc��
ACKNOWLEDGED BEFORE ME THIS �� DAY OF lJuj) 24 0 0
BY . &M �S ! ( V I i17�.S WHO IS PERSONALLY KNOWN TO ME , OR
.
HAS PROVIDED
AS IDENTIFICATION.
STATE FLORIDA County of S - L ,••,
,., SUSAN MONTENEGRO
„ 1JfY COMMESS40N # GG 099099
IGNATURE OF NOTARY ` •r a `= fTtn Not: April 2. 202
��PP�lt� Ba►deditwNotazY
-------------_------------------------------------------------------------------------------------------------------------------------------------------
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(%)j $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014