HomeMy WebLinkAboutPermit Renewals t
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
1 - BUILDING AND CODE REGULATIONS DIVISION—
. . 2300NIRG,INU AVE ;�!-1L3 tJ D
FORT PIERCE,FL 34482
(772)462-1553 Fax(772)462-1578
A U G 25 2020
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PERMIT RENEWAL BEQUEST tv, Permitting
PERMIT NUMBER: 1 `1. -cW ADDRESS: C i+
am requesting that the above permit be renewed. I.
understand that T must schedule and pass all-required inspections for the permit to be flnaled Further, I
understand that this is�a ONE.T ME RENEWAL and,the,perinit shall.expire-should I not receive a
passing inspection during'any six month period during the renewal.period.
Justification C.OV 1:Q - 1
OWNED LDR OR CQNMACTOR SIGNATURE DATE
Print Naafe'�
STATE OF FLOW
COUNTY OF ';',
ACKNOWLEDGED BEFORE ME THIS DAY OF Z'OJ
t
By O IS PERSONALLY KNOWN TO ME OR
HAS PROW D AS IDENTIFICATION.
STATE,OF FLORIDA,.County of
° J a p Notary Public State.of Fforiga
SIGNATURE OF NOTARY'. SEAL ; Amanda P Sanderson
My G.mmission GG 2t1255
Expires Q4125t2022
FOR OFFICE'USE ONLY.,
Number of Open Inspections:.
Total Inspections:
(Divide.open-by'total to get°lo of open inspections)
Percentage:
Original per nit fee: . x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x:65=S113 75(renewal fee)
Revised 712I/2014
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