HomeMy WebLinkAboutPermit Renewals 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
PERMITNUMBER: /��YeOd`�KDDRESS: 7O e; ��C��`���/��/�?
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 TIME RENEWAL and the permit shall expire should I not receive a
passing inspection.during any six month period during the renewal period.
Justification ,/'ria
OWNERBLDR O CTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS �'' \ DAY OF 4 20 Z,
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED- 3D L AS IDENTIFICATION..
STATE OF FLORIDA,County of
LJ_l�9\rl+\] .•":�"', ai:A1VNAMARIE GNEN3
+pry-...aIt
SIGNATURE OF N ARY
*; 5$ALK-Y COMMISSION#GG 022023
-w: F_X,F�IRES:December 16,2020
'.,�ft� o?= ;-i.::1"+hru Notary Public Underwriters
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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(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014