HomeMy WebLinkAboutPermit Renewals _ _.. PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
ME BUILDING AND CODE REGULATIONS DIVISION
•
• Mal W 2300 VIRGINIA AVE
-- — FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ! o 4�? ADDRESS:
I, c z- 04 ��/�.� ,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.
OWNERBLDR 0R N� CTOR SIGNATURE DATE
116 l/G /�J vl
rint Name
STATE OF FLORIDA
COUNTY OF S �. L u
ACKNOWLEDGED BEFORE ME THIS DAY OF
n Q y q 20�d
BY �1 1`U\-Z WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �-' t— AS IDENTIFICATION.
STATE OF FLORIDA,County of S k- L
its: MFANNAMMEGMy �HENS e?
~ 1*= CI�bN�f GG 022023
SIGNATURE OF NOTARY EXPIR"I *16,2020
'•ePg,;,t'`'' .Bonded TW No buy Rdrlic Undenvrfters
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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