HomeMy WebLinkAboutPermit Renewals PONNING AND DEVELOPMENT SE /, CES DEPARTMENT
` - BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
- - -- — FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
-70ZPERMIT NUMBER: G r� ADDRESS: `? � �6 �� ,�' VALkV Jell,
I,` 4� -- f-/ LA am requesting that the above permit be renewed. I
1; erstand 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 541�56W ' Z2902,�22 /bra W�2 ®gl �� �'O�h1✓ �
11111XIe-, orl-I ��ar 7� ®/�
O R/BLDR O - CTOR S A DATE
Print Name
STATE OF FLORID
COUNTY OF 5t
ACKNOWLEDGED BEFORE ME THIS DAY OF_ / /'G /'l 20 I d
BY a Arn L Mdt r'44 , AVC WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED AS IDENTIFICATION.
STATE O A,County of
Kamm
Notary Prick-Stab of Florida
IGNA OF NOTARY SEAL Commission FF 964608
my Comm.Expire:Jun 22,2020
°�� •��, Bonded through National Notary Assn
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