HomeMy WebLinkAboutPermit Renewal RequestPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVE.
FORT PIERCE, FL 34982
(772)462-1553
PERMIT RENEWAL REQUEST
ADDRESS: �20�.3 S� �. �� �. L,. !8'1 PERMIT Ske- 07,01" -dO/f
AM REQUESTING7R:
HE DO
RENE D FOR 18 MONTHS. 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 MONTHS PERIOD DURING THE RENEWAL PERIOD.
O R OR CONTRACTOR SIGNATURE DA
STATE OF FLORIDA
COUNTY OF
SWORN TO AND ACKNOWLEDGED BEFORE ME THISC)T DAY OF 20J0
BY jay 1� 7� IyIS WHO IS PERSONALLY KNOWN TO ME . OR
HAS PROVIDED X-% • �02 , j J AS IDENTIFICATION.
NOTARY PUBLIC, STATE OF FL RIDA
SEAL,
SIGNATURE OF NOT6AY COMMISSION NUMBER
FOR OFFICE USE ONLY:
RENEWAL FEE:
OPEN INSPECTIONS (_� X PERMIT
(RENEWAL FEE)
TOTAL INSPECTIONS:
SLCPDSD REV 8/5/2010
AUDREY B. HUMPHREY
a r MY COMMISSION # DD 633047
dt EXPIR58: March 6, 2011
Mtidsd Thru Nblery pUbl!a Underwriters