HomeMy WebLinkAbout2002-0718 Permit Extension RequestPLANNING 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: 0600-•-OBI � ADDRESS: `"! C,� 3a G da l.L_ ( i
I, f l CIA Q 1p, t -• 1 � � .0 1�tl'�t�1 , 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 �)no i6. /M.(A O i 5 k A c i•t ACA rkP (61AS
SIGNATURE IYATE
r.
Print Name
STATE OF FLORID111
COUNTY OF C 'e �1
ACKNOWLEDGED BEFORE ME THIS DAY OF 1�e C4.OA -t ( .20 /-6
BYk-dbC-&( I , � l�C> WHO IS PERSONALLY KNOWN TOME L/ . OR
HAS PROVIDED ii AS IDENTIFICATION.
CTEe
MEE
ic State of Florida
Newman
SIGN TURE F TRY SEALsion GG 221434
3/2022
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 7121/2014