HomeMy WebLinkAboutPermit Renewal 2001-0317 PLANNING 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: --�X)0} — 31 —1 ADDRESS: 6 � 3 K ti S
I, -- LQu -) L00l i C--:�:a K— am requesting that the above permit be renewed. I
understdrfd 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.
Justification
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O LDR OR CTOR SIGNATURE DATE
Print me
STATE OF FLORIDA
COUNTY OF .
ACKNOWLEDGED BEFORE ME THIS DAY OF A20
BY W ZQWHO IS PERSONALLY KNOWN TO ME OR
HAS PROVI D AS IDENTIFICATION.
STATE OF FLORIDA,County of_ � '�_• _ �� �
�p0 Notary Publie State of Florida
SIGNATURE OF NOTARY SEAL Amanda P Sanderson
�. My C ;omission GG 211256
Expires04/25MV
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(1/o)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/2I/2014