HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
i 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 0583ADDRESS: 52-01 C-hus Aye for+ 1 lam
1, ,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 -Perm t-� GX&ej
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OWNER/BLDR OR CONTRACTOR SIGNATU DATE
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Print Name
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STATE OF FL A
COUNTY O l 9'� VIM
ACKNOWLEDGED BEFORE ME THIS DAY OF 20�
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
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STA OF FLORIDA,County �;�;- ,. '' :ci A nt,
NATU OF NOTAR
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FOR OFFICE USE ONLY:
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ANGELA MOSS
Notary Nblic-state of Florida
Number of Open Inspections: ;f� = Commtssto,#GG 123447
Total Inspections: '��c„r .�„cc2.` MyComm.ExpiresNov7,2021
(Divide open by total to get%of open inspections) Bnndrdlhrnu9hNaUana1NotaryAssn,
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