HomeMy WebLinkAboutPermit Renewals 07/05/2020 SUN 10: 41 FAX 772 877 2735 White Aluminum — PSL 0002/002
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
' COUNTY BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)467,1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMPr NUMBER: ! 1-05-f G ADDRESS: qCQ5. 0 V( OT- b/ y
I, 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 Jet° S
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
cowl -
Pant Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF `J .20
9-0
BY YLf.V � WHO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF 4FNOTARY
,Co
ow Notary Public State Of Florida
la 'Angela Staples
SIN TUR SE Y commission GG 235102
o'M1 Expires 07/04/2022
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 = $-Z62�?Renewal fee
Example: [15 divided by 23=.65(%)] $175.(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014