HomeMy WebLinkAboutPermit renewalCOUNTY
r L 0 R I D A
7 ;iIT1118 lUS1:171:71
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRMNU AVE
FORT PIERCE, FL 34M
(772) 462-1553 Fax CM) 462-1578
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PERMIT RENEWAL REQUEST
ADDRESS: (oOZg cSo n+a /Nicol- a.rl4-o Dr
I, S4-{ tP k n Lou%%b{r'-- , 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 -./ P 2 J iO C t na I r &rm f i-
CONTRACTOR SIGNATURE
S--6? to L o, ry\be lr-L
Print Name
DATE
STATE OF FLORIDA
COUNTY OF JO l tnn aL k
ACKNOWLEDGED. - BEFORE ME THIS �- U DAY OF J;7t n L4-0,r �/ , 20 Z l
BY S `� 1 k \ Lot IM betri— WHO IS PERSONALLY KNOWN TO ME l/�, OR
HAS PROVIDED
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
u q.rrtn r e .
�,V' Notary Public Stale of Florida
Theresa Fillet
p �pR a My CommlasiW GG 20N27
�i dF Expires 01/032020
4
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$I13.75 (renewal fee)
Revised 7/212014