HomeMy WebLinkAboutPermit renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
• BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 NOV 2A 2020
PERMIT RENEWAL REQUEST Pers ittLugie count Department
i PERMIT NUMBER: 9 C'4 2`!' . ADDRESS: `,p
416 0 A)A-
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I, AQMM>p 4-_-tf,S Ib ti`C>V ,am requesting that the above permit be renewed. I
understand that I mu At schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TEWE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification LpY1� rh YJ -I*r�Cyr��-
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OWNER/BLDR OR CONT CTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF S t L'-X C I-e
ACKNOWLEDGED BEFORE ME THIS `'�DAY OF 20
BY �'tl-(1((1(� \ t.I'�.�O LN.e p WHO IS PERSONALLY KNOWN TO ME OR
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HAS PROVIDED F L_ '� �-- AS IDENTIFICATION.
STATE OF FLORIDA,County of ST
SIGNATURE OF NOTIWY SEAL
ELLEN VAUGHN
Public
_Mate of Florida-�lotary n079
�= Co Mk fires
FOR OFFICE USE ONLY: p`c My Commission Ex 2
i9TF0F F��P�` Octoberr 22,.202
Number of Open Inspections: -
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
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Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised MV2014
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