HomeMy WebLinkAboutPermit Renewals • -N,)ti1}fir+•, .
'PLANNING AND DEVELOPMENT SERVICES DEPARTIMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIAAVE
FORT'PIERCE,FL 34M
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERWr_ ER
M: " 4er�i P.( l ult'W� ►'1 Q/1� ,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 T IE•RENEWAL and the permit shall expire should I not receive a
passing-inspection d i g any six month period duri33gte renewal period.
Justification
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
L„E Print Name -�
= COMMWOM208194
E.*.A907,2M
j'..,
STATE OF FLORID
` COUNTY OF
ACKNOWLEDGED BEFORE ME TH1S oa DAY OF C JIB 120 DO
BY WHO PERSONALLY KNO TOME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
S1 OF NOT SEAL
HII.I-
}° 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 = S Rzwwal fee
•Example: [15 divided b'y 23=.65(%o j( $175(permit fee)x.654113.75(renewal fee)
i •' ' Revised 7/21/2014
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