HomeMy WebLinkAboutPermit Renewal Request1�
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PLA1V1vING AND DEVELOPMENT SERVICES DE PARTMEi NT
• Building and Code Regulations Division
2300 vIRGINIA AW.
FORT PIERCE, FL 34982.
(772)462-1553
PERMIT RENEWAL REQUEST
ADDRESS: jo3 M CCL PERMIT NUMBER
am requesting that the above permit be
renewed. I understand that I.m su t 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
OWNER/BLDR OR CONTRACTOR SIGNATURE, DATE
i
Print Name
r
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF, r , 20/.
BY
HAS PROVIDED
STATE..OT+ FLORIDA, County of
WHO IS PERSONALLY KNOWN TO ME , OR
FOR OFFICE USE ONLY:
Number of Open inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:.
AS IDENTIFICATION.
,PRvn�o, SANDI COOPER
Notary Public - State of Florida
SEAL. 1. =• n n Commission 7k FF 915690
My Comm. Expires Sep 7, 2019
Bonded through National.Notary Assn.
Original permit fee: x NO open = $ Renewal fee
.Example: [15 divided by 23=.65(10/o)] $175(permit fee) x .65=$113.75 (renewal fee)
I
Revised 6l24M14