HomeMy WebLinkAboutPermit renewal requestPLANNING 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 NUMBERS 1 (,(/ �310 2 ADDRESS: 1 t C� 7 %� {�j/j h� Y`�lS�.
' 56rmr , am requesting that the above permit be renewed. I
understand thdf I mot 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 dun*(n#�,,the renewal period.
Justification -�(D l V-e — i M17il % 1-� ` 1-Y11 PM,l a1 Yi 11A} 14TV 11
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CONTRACTOR SIGNATURE
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Print Name
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STATE OF FLORJPA COUNTY OF . t o-
ACKNOWLEDGED BEFORE ME THIS DAY OFyyemb(p1, 202p—
BY �X � �' l j y , A WHO IS PERSONALLY KNOWN TO ME �/ , OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA, County of
�.VT Notary Pu
blic
SIGNATURE OF NOTARY SEAL Craig AMy Comurn/ Expues
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(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014