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
PERMIT NUMBER: \ - ` l� �J o ADDRESS: 9 (Ci : „(kexcf- *
I' , LW ( am requesting that the above permit be renewed.
understand that I must schedule and pass a 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 j u) Q S' API P 1 A (\04 (''.ID ,.I
` II
OWNER/BLDR OR CONTRACTOR SIG A �* k 1-7'A
DATE
Print Name
STATE OF FLORI
COUNTY OF VrVal
ACKNOWLEDGED BEFORE ME THIS l -1 DAY OF
BY i - �0 2�
WHO IS PERSONALLY KNOWN TO ME
. OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLONIDA, County of S--� ( A r'I
e ..
Taylor O'Brien
SIGNATURE O OTARY �' NOTARY PUBLIC
"� STATE OF FLORIDA
Y ' Comm# GG958999
Expires 2/17/2024
FOR OFFICE USE ONLY:
?dumber of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee o
x /o open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/212014