HomeMy WebLinkAboutPermit renewal NOV-25-2020 06:14A FROM: TO:17724621578 P.1
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PLANNING 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
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PERMIT ER: 'J CI ADDRESS:
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am requesting that the above permit be renewed. I
under tand 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 inspe on duns an six month period during the renewal period.
Justification ;
OWNER/BLDR QR CONTRACTOR SIGNATURE DATE
Print Parne
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STATE OFF DA
COUNTY OFF
ACKNOWLEDGED BEFORE ME THIS �'/ DAY OF 20�
BY v� C/1 SPY U tF't" WHO IS RSONLY KNOWN O ME OR
HAS PROVIDED AS IDENTIFICATION.
T OF FLORIDA,C D+�
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SI A E OF NTARY SEAT
=Y a'.= EXPIRES October 5,2023
°Wt,''� BondedThru Notary Public Undmniters
FOR OFFICE USE ONLY:
Number of Open Inspections.
Total Inspections: i
(Divide open by total to get%of open inspections)
Percentage: i
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