HomeMy WebLinkAboutPermit renewal I
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING,AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCF,,1F'Ta 34952
(772)462.1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT'NUMBER: 2001
.d_/_ ADDRFss: /� y� �/S�i�/�1 c✓ �?�
I 1 G G t �� �~ ,117IA requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections fir the permit to be finaled. Further, .Z
understand that this is a ONE.TUVZ RENEWAL and the permit shall expire should I not receive,a
passing inspection during any six lrsmoutb.period during the renewal period. j
Justification $Ur�D �j T�rtpp/ a/"G, ! G c a '/ �. C+a�✓ G?J ,
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OwNERMT.,DR Q_R CONTRACTOR SIGNATURE DATE
Print Name
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STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS�DAY OF ,20
BY WHO IS PERSONALLY KNOWN TO> ,OR
HAS PROVIDED AS IDENTr TCATION.
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STATE OF FLORIDA,County of
SIGNATURE Or NOTARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections: j
Total Inspections: ..-___- ------_----.-.---
(Divide open by total to get%of open inspections)
Percentage:. _-.-.--
Original permit.fee: x%open $ Renewal fee
Examplo: [15 divided by 23=.65(%)] $175(pc.rrn fee)x.65-$113.75(renewal fee)
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Revised 7/21/2014
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