HomeMy WebLinkAboutPermit renewal request - DesjardinsPLANNING 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: d❑❑� �2 C1 ADDRESS: 12� � i S. iC� Te.C' f " e'tcz) C- -3q q's
I, f W� e r , am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be f"inaled. 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 40me. 0U_)nC4- Lo 1A r1G 4 of U_)O_�7Unokl-e_
Come bG1 C e- 4o 4he U. r .
1 3C12. 0 2-a
OWNERIBLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS
DAY OF 00-kbZf'
, 26 20
By W �� d �. r WHO I OWN TO ME OR
HAS PROVIDED
STATE OF FLORIDA, County of
SIGNATURF OF NOTARY
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
AS IDENTIFICATION-
n Public State of F�vrsda
Jennini fer ! Aguisr
SEAL My Comftsrion GG 339571
Expires 05n912023
Example: [15 divided by 23=.65(%)l $I75(permit fee) x .65=SI13.75 (renewal fee)
Revised 7.21 2014