HomeMy WebLinkAboutPermit Renewal Request1
PLANNING AND DEVELOPMENT SERVIC'`L+ S DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGMIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 4624578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 14 ADDRESS:\tQ) ,'�`j g,Q)Qe w\ IN .In —NW— -
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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
�orc� rv-, 4% Q -e— AA,-.
OR
Name
STATE OF FLO A
COUNTY OF `�&t
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DATE
AC`KNNOOW�LEDGED BEFFO`RE ME THIS -S DAY OF , 20A!5
BY 1 �Y.V 'o,'m Fl L. w WHO IS PERSONALLY KNOWN TO ME ✓ , OR
— r-f'.V lS S-�v Ac
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA, County of STELA M. HUNTER
�: Notary public -State of Florida
-MATURE OF NOTARY Commlaalon N FF 180552S mmExpiresJan 23, 2015�
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 MM2014