HomeMy WebLinkAboutPermit Renewals From: 08/03/2020 13:00 #811 P.005
.._.___..,___.__,.,._..__...:... :._,._...:... PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
„ s BUILDING AND CODE REGULATIONS DIVISION
.w 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: lG6 D/GZ ADDRESS: /0.0,v S e/l/.�j /
1, G dt /� ��570 A-" ,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.
Justification0rx _�..o��/ovs levw �h,�,, /.���rT 1 7--
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�it,✓t�.� oma.r,: r,� a�
OWNERS DR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORID.;//
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 3 ( DAY OF �✓ �y 20 Z.U
BY �� 4/� r STdN WHO IS PERSONALLY KNOWN TO ME_��OR
HAS PROVIDED /f AS IDENTIFICATION,
STATE
EOOF�FL IDA,County of 4p'tOy/ tttyauq� MICHAEL WPICKER
0.,.w
Commission#GG100802
SIGNAT(JRE OF NOTARY � d' Expires June 22,2021
� Bonded ThruludgetNemryStrilm
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(pennit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014