HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
r - BUILDING AND CODE REGULATIONS DIVISION
•
• 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: /2®�—(/D!` ADDRESS: C(/ ' �T Z C J��/CL�L�y/i•�
I, (/��¢dL /�+- - �yr� ,am requesting that the above permit be renewed. I 7 7
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 c
OWNER/BLDR_ O CTTOOORRSIGNATURE DATE
i6el-1
Print Name
STATE OF FLO DA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS a`� DAY OF a\�13 20 ad
BY o.J h y _Z' WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED ` L- AS IDENTIFICATION.
STATE OF FLORIDA�SIGNATUREOF County
of S k ��t\ "+"'•,_ DEANNAMARIEGIVENS
MY COMMISSION#GG 022023
;e EXPIRES:December 16.2020
"� „F„•,;o-•'• �s7AdQd T!w Notary Publx Underwriters
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