HomeMy WebLinkAboutPermit Renewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 19 �' " OHS �1 ADDRESS: --7 SCE 1 Pa t G'MU\"-
I, "v-,z (,(-( i-ALA l , 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 e n V-,\ ;nf C J S :J\Ocd
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OWNER/BLDR OR CONTRACTOR SIGNATURE DAT
IVAMK�. CQu)66\
Print Name
STATE OF FLO DA
COUNTY OF
ACKNOWLEDGED BEFORE ME THISQn j DAY OI` Oac lm 20 O V
BY bay, 6w CJ rC—I ( WH PERSONALLY'KNO TO ME OR
HAS PROVIDED
AS IDENTIFICATION.
S:.Nine 27, 2022
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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