HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISIO>kace'<VF
2300 VIRGINIA AVE
FORT PIERCE,FL 34982_
(772)462-1553 Fax(772)462-1578
permitting�Coin vent
St.Lucie
PERMIT RENEWAL REQUEST
PERMIT NUMBER: o d _I-dal ADDRESS.
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 1 -O -O G 0 - 3
O DR O CONTRACTOR IGNA DATE
P int Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS ~ 1 DAY OF e—r—
BY 9.�!' ` W�k�r �� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED 1D AS IDENTIFICATION.
STATE OF FLORIDA,Co ty of
- DEANNAMARIEGIVENS
SIGNATURE OF NO Y MY COMMIS�1 4#GG 022023
=U, o EXPIRES:December 1ti,2U20
%FOF f�gip' Bonded Thru Notary Public Underwriter:
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