HomeMy WebLinkAboutPermit Renewals 'lip
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE ® .
FORT PIERCE,FL 34982 F, r
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST ; zo/J
PERMIT NUMBER: I � � ADDRESS: �W U y MJ —k"VV 'Ty l
_____,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 \ In V)
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Cool knct �J rf-p golnc� wn
OWNE B DR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLO
COUNTY OF �-ll �
ACKNOWLEDGED BEFORE ME THISwA DAY OF
BY � � ))n(OJJ�RX-14ERSO'NALLY KNOWN TO ME OR
HAS PROVIDED �I 1 cat ` l L`� c:\fj AS IDENTIFICATION.
STATE OF FLORIDA, ounty of L—aQW----2
ti �o� va JENNIFERCORSON
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F NOTARY SEAL 40"
* C0r=ss(oo#GG 156192
EXPWS October 30,2021
Fa`O! Bonded Thru Budget hbtwy$,pkes
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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