HomeMy WebLinkAboutPERMIT RENEWALPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
d 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1,578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: _ j iJ D (Q 0 U 9 2. ADDRESS: -7 5 8 6 U, S 4 G kd'av -
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
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OWNER/BLDR OR CONT1yXTOR SIGNATURE
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Print Name
STATE OFF DA
COUNTY OF zZ on -Re e k
:7 12-012-0
DATE
ACKNOWLEDGED BEFORE ME THIS �- �% DAY OF ��(� Y 201 y
BYTO-- '� I C k T-�� D WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED
ST4TE)Oy FLORIDA, County of
TUNE OF NOTARY
AS IDENTIFICATION.
1PRYPLB KIMBMLYA.WE1R
SE Commission # GG 167423
• Spires February 3, 2M
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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