HomeMy WebLinkAbout20070532 PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
i BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
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PERMIT NUMBER: 6" r ADDRESS: r J ST pl
I, \J 1"M4 (\A60 16 ,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} Vo((
Justification U[j�(,--P ID I((�0 CQQ11-R- I`Cl (/d 1rd Vy� 16/,/
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OWNhrOffLDR OR O T_RA TORSI .NATI rn� DATE
Print Name
STATE OF FLORIDA ,
COUNTY OF
ACKNOWLEDGED BEFOq ME
THIS��DAY OF .20 .4211C.
Cr",
BY A �f /) WHO IS P ONALLY KNOWN TO ME ,OR
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HAS PROVIDED r- Jgzc - AS IDENTIFICATION.
STATE OF FLORIDA,.County of �' zu t'
SIGNATURE OF TOTARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections: `ots+pu�c; AUDREY B.HUPrIPHREY
.: MY COMMISSION#GG 300817,7
Total Inspections: '* EXPIRES:March 6,2023
(Divide open by total to get%of open inspections) '• BondedThru Notary PUMGUndenvrt
Percentage: -nded
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