HomeMy WebLinkAboutPermit renewal, 2nd ti me PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
01 BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: / /"V ADDRESS:. 27
� � l/ JT 1111 O�f �✓ �)
I,,1' / 1Y1 JAG' (It "-' 'AJO��— ,am requesting that the above permit be renewed. I
and re stand 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
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OWNVJBLDR OR CON RACTOR SIGNATURE DATE
6 C� '14e //�c d
Print Name
STATE OF FLORIDA C`
COUNTY OF ��' Lua&
ACKNOWLEDGED BEFORE ME THT3 rY Ol �J C/ '(q
20
BY �tIL)JOV6L- WHO IS PERSONALLY KNOWN TOME_ ,OR
HAS PROVIDED p AS IDENTIFICATION.
STATE OF FLORIDA,Countyof �'lac,(LJ
JOYALIPPARD
4'A Af Commission#GG 236838
SIGNA O NO Y es August 4 2022
� 0 � Bonded Thru Troy Faln Insurance 800-385.7019
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(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014