HomeMy WebLinkAboutPermit Renewal_Soltis_1411-0049PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMT RENEWAL REQUEST
PER vI1T NUMBER
l�J g.DDRESS:
1 C( t e(�! ��YJ ►'t Q/lc� , am requesting that the above permit be renewed. I
understand that I must sch le and pass all required inspections for the permit to be finaled. Further_ I
understand that this is a ONE TIMERENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period durigg�t�he renewal plriod,_
Justification
OWNER/BLDR OR CONTRACTOR SIGNATURE
K
Print Name
STATE OF FLO A
COUNTY OF
7 9 Q 0-,-�0
DATE
AMBRUIRV
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ACKNOWLEDGED BEFORE. ME THIS _ DAY OF l�C�v 20 cab
BY I� I m 6� S( __ WHO ISjh �LLY Kh'QW�I `To ME OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA, County of �1_���L ✓ 1
SI _ A OF NOT SEAL
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