HomeMy WebLinkAboutPermit Renewals i
4l, A PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMITNUMBER: 1701-0077 ADDRESS: 3932 Shoreside Drive
I, Ali) z at— am requesting that the above permit be renewed. I
understand that I Phust 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,/
*WREPJBLDR OR CONTRACTOR SIGNATURE DATE
'nt Name
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i STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE FLORIDA,C ty of
f %L4&,,F� Notary Public State of Florida
SIG ATURE OF NOTAR g Frances Donza
My CommlesiLID 092440
Expires 07127/2021
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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(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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