HomeMy WebLinkAboutPermit renewalPLANNING 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: / 50 ¢-a / 7/ADDRESS.. ]JP00 a U:S I ____
am requesting that the above permit be renewed. I
understan that I mus
understapd that.this.is p ONE TIME-XPNEWAL and tfie permit shall expire shau-la Tn-6-t-r~:cei-vJ;
on duripassing insp
Justification
schedule and pass all required i-nspectTons for the perriit to be finaled. -Fu-rther, I
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SIX renewal
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prfuNN% / 4~
DATE
STATE OF FLORIDAcOENTyor|£r fual4-__
ACKNOwLEDGED BEFORE ME THls ± DAy oF _"Orde,4~ _ _ _, 2Oj2£
BY ___A~b^£z l±j?v~ ___WHols
rIAs pRovlDED
ERSONALLY KNOWN TO ME
AS IDENTIFICATION.
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---.--_------------------------------------------------------------------------------------------------------.__---._-_
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get °/o of open inspections)
Percentage:
Original permit fee:x%open -S Renewal fee
Example: [15 divided by23=.65(%)] $175toermit fee) x.65=$113.75 (renewal fee)
Revised 7/2 I /201 4