HomeMy WebLinkAboutPermit Renewals -PLANNING AND'DEVELOPMENT:SERVICES DEPARTMENT
BUILDING AND CODE.REGULATIONS DIVISION I ,
2300 VIRGINIA AVE i
FORT PIERCE' FL 34982
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772)462 553 Fax(772)462-1 8 � }f
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PERMIT RENEWAL REQUEST
Lucie l our�ty Pei r°ittira }
PERMIT NUMBER:. 7 0 -10 ADDRESS: Y9D fio ..S'Gc S
I, ctS'e vrt/ ,am:requesting that the above erniit 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 peririit.shall expire should I not receive a
passing inspection during anysm month'period during the renewal period.
Justification
L � ,
OWN BLD. OR CONTRAC SIGNATURE . DATE
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Print Name
I '
STATE OF FLO,I�U�
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COUNTY QF re �
ACKNOWLEDGED BEFORE ME.THIS�, DAY OF 20O
BY . �oS 2,p �. �• WHO IS PERSONALLY KNOWN:TO ME� ;OR 1
HAS PROVIDED 'As IDENTIFICATION.
STATE OF FLO _ of
Notary Pubhc.State of Florida
! Gregory F Espdsdo Jr.
SIGN TUR: Y SEAL My Comm!asion GG G22224
p expirea;10H.3/2023:
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-. 1-5 divided by 23=.65 %. $175" ermit fee x.65=$113 75 renewal fee
Revised 7/21/2014