HomeMy WebLinkAboutPermit Renewals PLANNING 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: I o p� 'V ADDRESS: 7 • n1°kt (1 S
I, ,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
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
. 7c2� � (� �J a � ►� Cim ✓�
Print Name
STATE OF FLORID
COUNTY OF �►9
ACKNOWLEDGED BEFORE ME THIS��DAY OFj—>C --20/
WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED 62' 1V AS IDENTIFICATION.
STATE A,County of
SIGNATURE OF NOTARY SEAL
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FOR OFFICE USE ONLY:
Number of Open.Inspections: D
Total Inspections: — V
(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 E
DEC 19 2017