HomeMy WebLinkAbout2020-09-21 13-40PLANNING 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
PERMIT NUMBER: (, - Oho ADDRESS: 3l 2 -f OCNrvtr
I, Yc' � r � C (( S t 'gt(-., , am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be fmaled. 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
Print Name
STATE OF FLORIDA
COUNTY OF
ACKN7EDGED BEFORE ME THIS Zl DAY OF ��(.fc T�i 20
BY I t` cy— < WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED Fib C— AS IDENTIFICATION.
STATE OF FL A, County of Sc)-. -+
S�LY . JEANNIE M. ANDERSON
illfNotary Public - State of Florida
SIGNATU TARY SE '? a ry.!,
Commission 0 GG 308099
.. My Comm. Expires Mar S.
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: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014