HomeMy WebLinkAboutPermit Renewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
2300 VIRGDUkAVE.
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462=1578
OK5-�D PERMIT RENEWAL REQUEST
PERMIT NUMBER: 0 v 0 002 ADDRESS: V.Z a o AeOl e'_ V-I dil t
1, 12Z` f-.1,aC-,0 Pe-7 2/' S , 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 • C X S PI � e-�O
2-1q
0WNE1tBLDR OR CONU ACTOR SIGNATURE DATE
1Zo ,vim ens
Print Name
STATE OF FLORID
COUNTY OF
ACKN WLEDGED BEFORE ME THIS U DAY OF AD- y , 20_/�/
BY Ci WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED 1®/'`� AS IDENTIFICATION.
S E OF FLORIDA, County of
�• pSPpy f •�• DAWN MILONE
'�=_ 'otary Public -State of FI '1a
SATURE OF NOTAR
t ; • « ggAl Comm. Expires Mar 22, 2017
E �
%9�FO0" Commission # EE 877571
j......
" , Bonded Through National Notary Assn.
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FOR OFFICE USE ONLY:
Number of Open Inspections: ((�
Total Inspections:
(Divide open by total to $Jet % of open inspections) &
Percentage: @1� ((
Original permit fee: ?� �' x % open = $ Aenewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 6/24/2014