HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
a BUILDING AND CODE REGULATIONS DI"SI.Q-W-
2300 VIRGINIA AVE T '[i:•. •.
FORT PIERCE,FL 349.82"
(772)462-1553 Fax(772)462?1578
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PERMIT RENEWAL 12EQUEST'
PERMIT NUMBER: I U LW —�I�� ADDRESS: 2-W)V 2
am requesting that the above,permit be renewed. I
de
unrstand that I must schedule and pass all required inspections for the.perm#.-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 -r—i n C LI (1��L-e C-n(L,,ny\A S
(Tjmjj�- ?AZO
O ERIBLDR OR CONTRACTOR SIGNATURE DATE-
Com.
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Pnnt Name
STATE OF FLORID L 1 i 1 / .�
COUNTY OF I` '
ACKNOWLEDGED BEFORE ME THIS DAY OF. ` ry : 20 2D
BY.,TLAUS C'1I/a lCL4— 1 WHO IS PERSO LLY KN�OWNO MEOR
HAS PROVIDED AS IDENTIFICATION. .
STAYE OF FLORI o of
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r • Commission�: n,�
* " ExplreSNOVember2.2023 a 1
SI NA RE OF NOTARY SEAL ��7►O!
•° Semis
9jk P BondadilwBud9. .
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
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