HomeMy WebLinkAboutPermit Renewal 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
PERMIT NUMBER: ��/L/^('/f r'p�
I, "`TTT ADDRESS:E( � 3—?t6�1('o1J"-l(/t Pd 6
---- ,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
OWNER/B OR CONTRACTtlk SIGNATURE DATE
X
/ A-
IFrint Name
STATE OF FLORIDA
COUNTY OFZ_
ACKNOWLEDGED BEFORE ME THIS l�. DAY OF fn 20-P(�`
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED (_, AS IDENTIFICATION.
STATE OF FLORIDA,County of 6 4- y.Lsz'r
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SIGRATUREOFNOTARY SEAL =oa ;
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Number of Open Inspections: 6 3 H T=
Total Inspections: 3 0 o m
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(Divide open by total to get%of open inspections) o N,a a Co
Percentage: N� D o c
Original permit fee: x%open = $ Renewal fee o x
ND.W O
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee) m
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Revised 7/21/2014