HomeMy WebLinkAbout2006-0657 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: d(Aa'd (6 ADDRESS:y® y `� (�((�(�j 'l/� CQ Co
I, (i 1 a1 ,Vy" 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 inspectior�during any six month period during the renewal period.
Justification' VOO k ( CJIAAI i _ K r'(,l/ t d 4e,(0 LAS
SIGNATURE DATE
Print Name
STATE OF FLORID
COUNTY OF �� , ULC C -e 0
ACKNOWLEDGED BEFORE ME THIS dD- DAY OF 20_
BYI�A C-hU-6 [J"WHO IS PERSONALLY KNOWN TOME ----�OR
HAS PROVIDED
STATE OF L o my of j' Lu cc e
SIGN URE OF O ARY
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
AS IDENTIFICATION.
410
'Votary Public State of FloridaFrancene Newman
SEA +' nMy Commission GG 221434�""faaExpires 05/23/2022
'Example: [15 divided by 23=.65(0/o)] $175(permit fee) x..65=$113.75 (renewal fee)
Revised 7/21/2014