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
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1 O 1 I ADDRESS:L/� r � Trot
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
II
OWNER/BL QA 6ONT CTOR SIGNATURE DATE
Print Name
STATE OF FLORjB1/
COUNTY OF ��fQ�
ACKNOWLEDGED BEFORE ME THIS OF 'Dec, ,20j�
BY � �I �`�� r 1��W,JHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �CJ SCY�L l ll�' L AS IDENTIFICATION.
STA OF FLORIDA_,County f JpNNR CORSON
* * Commission#GG 156102
SI O NOT Y Ny'FOF oP B�m October ,2
ThN �N0 *ON s
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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