HomeMy WebLinkAboutPermit RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIrS AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER:. —MG r ADDRESS: �� �� �r•
am requesting that the above permit be renewed. I
understand that I n ust 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 _ 1 r I��
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Print Name
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DAIfE
STATE OF FLORIDA
COUNTY OF
ACKNOW'LEDGED BEFORE ME "I'HIS A; DAY OF ^ U-A - 20 O
BY � }� WHO IS PERSONALLY KNOWN TO ME OR
I-JAS PROVIDED
AS IDENTIFICATION.
STA�NATURE
FL iD County of �..t ie _ RICHY GOMES, JR•
°�,•� Notary Pudic -State of Florida
►� Commission # GG 966763
S1 OF NOTARY" SEAL i�, phy Commission Expires
��jOF f4\ A+iarch OB, 2024
III III
FOR OFFICE USE ONLY:
Nuinber of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = S —Renewal fee
Example: [15 divided by 23—.65(1/o)j $175(pennit fee) x .65 1113.75 (renewal fee)
Revised 712112014