HomeMy WebLinkAboutPermit RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST An I
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Lucie
- County, Perm
PERMITNUMBER: 410 -020a' ADDRESS: KI % {'l l-llow HyC
I, .12AJZJO� /'✓fonl j GGA j/0 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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Print Name
,7 �/4/ao
DATE
sa d, -&"I � Is
STATE OF FLORIDA
COUNTY OF SA-, L
ACKNOWLEDGED BEFORE ME THIS A DAY OF 5� � � , 20 ai
BY WNgt`iyWHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED �� ' AS IDENTIFICATION.
STATE OFFLORIDA ��k•
MYCOMMISSION # GO 022020
Notary PubHo
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 7/212014
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