HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
' ��' ' - .. - _ BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RE r
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PERMIT RENEWAL REQUEST IMgR`off Z®��B vtolig O
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PERMIT NUMBER: 1 703-0185 ADDRESS: 7932 MEADOWLARK LN
I, J U ko V 0 ,am requesting that the above permit be renewed. I
understand t1lat I must schedule and pass all required inspections for the pen-nit 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 40 6424 64-KF C-A y
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OWNER/BLDR 6R CONTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLORIDA
COUNTY OF ;
ACKNOWLEDGED BEFORE ME THIS DAY OF— 20 IV
BY �� Ld 'VVW 0 IS PERSONALLY KN�TO ,OR
HAS PROVIDED p — AS IDENTIFICATION.
STATE OF FLORID ty 0f _ !1 it/ rA
otpgY aUe��c PAMO ARES
z MY COMMISSION#FF 998006
SIGNATURE F Y SEAL, oX EXPIRES:June 1,2020
9rFOFF � Bonded Thru Budget Notary Serviws
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
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