HomeMy WebLinkAboutPermit RenewalJun 12 20. 02:17p Ricciardis Heating & Air
1-863-357-0790 p.1
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
lsco*IBUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
- FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-3578
PERMIT RENEWAL REQUEST
PM,ffTNUMBER:yII'" 0/(F/ ADDRESS:_,gyZlj
am requesting that the above permit be renewed. I
understand that I must schedu]e and pass all required inspections for the permit to be finaled. Further,
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 %P ')/; c
OWNER/BL,DRORCON
T IGNATURE DATE
Pant Name
STATE OF FLORIDA
COUNTY OFQ ,/lam ,
ACKNOWLEDGED BEFORE ME THIS /-:I- DAY OF / (w AA 20 00
BY t�a ! n� A.C. < " , 6 WHO IS PERSONALLY KNOWN TO hIE OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OFF RIDA, County ofii��4o �oe
V,
SI A R V' AR Vs 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(°/u)] S175(petmit fee) x .65=$113.75 (renewal fee)
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