HomeMy WebLinkAboutPermit Renewal06/10/20 11:11AM EDT 186648074981 —> 7724621578 Pg 3/3
S'
> s PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUIILDING AND CODE REGULATIONS DIVISION
2300 VIRGRGA AVE
FORT PIERCE, FL 34982 '
(772) 462.1553 Far (772) 462-IS78
PERMIT RENEWAL REQUEST
PERMITNUMBER: ADDRESS:gil�Q tk4� C.'��( �12c� \
fa 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 file permit shall expire should I not receive a
passing inspection duri
Burin any six mo th period ng the renewal period
- -SFR.TRRMTnR nu MMTR A['TnR .9IC;NAT[)BE DATE
Print Name
STATE OF FLORIDA
COUNTY OF lU�
ACKNOWLEDGED BEFORE ME THIS _�, DAY OF J V • 20 av
BY wHOISPERSONALLY KNOWNTOMB--OR
HAS PROVIDED
STATE OF FLORIDA,, County
AS IDENTIFICATION.
of�-
- =miss'i.o'nn
ATTON
Notary Public
2022
---- GG 215220SF'M'ion Expires07
FOR OFFICE USE ONLY:
Number of Open Inspections: _ -
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original parmit feE: _ x % open = 5 Renewal fee
Example: [15 divided by 23=.65(%a)] $175(permit fee) x .65- :SI 19.75 (rcncwel fc )
Revised 7212014
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