HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
WNW
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER-,Or- e,-O r,3 V ADDRESS: /2- /J &' ��t�►`4 1 V 13��- IV
I, otwtok
,am requesting that the above permit be renewed. I
understand t&t I must schedule d 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 an ix monT period during the rene al period.
V
J stification WC—
►yt " l
OWNERLDR OR�CON
B ,ZCTOR.SIGNATURE DATE
C21
� �!
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 2( ,�
BY ( WHO IS PERSON �LYOWN TO ME OR
HAS PROM AS IDENTIFICATION.
S F ORIDA,Count of
�toaty Kelly Molloy
oe NOTARY PUBLIC
SIGNATURE OTARY7TE OF FLORIDA
2 Comm#GG238684
INCE 19�e Expires 9/18/2022
FOR OFFICE SE 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 7121/2014