HomeMy WebLinkAboutPermit renewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA A VE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEW AL REQUEST
PERMIT NUMBER: Z~6 ':J .--6 b ,c;-ADDRESS :
I,--:---~,----~---,-----,-----,-----,----,-,---' 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 RENEW AL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification ------------------------------
0~ O~SIGNATURE DATE( !
Print Name
ST A TE OF FLORIDA L
COUNTY OF <;-r L-vu-t.
ACKNOWLEDGED BEFORE ME THIS 2-S DAY OF °"5P\.tl\. 20 2, , --
BY _JV\J\'---"-'-~t,,1..;du...t--..Jffi_'--'----'"e4-Q'.)"---"---"'--.L.._-----WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED ___________________ AS IDENTIFICATION .
SEAL
FOR OFFICE USE ONLY:
Number ofOp~Inspection s: __
Total Inspections : ____ _
(Divide open by total to get % o f open inspections)
Percentage: ______ _
Original permit fee : ____ x % open = $ ____ Renewa l fe e
Example : [ 15 div ided by 23=.6 5(%)] $ I 75(p ennit fee ) x .65=$113 .75 (renewa l fee )
Revi sed 7/21 /2014