HomeMy WebLinkAboutGreer RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COU
NTY BUILDING AND CODE REGULATIONS DIVISION
��-■w 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: WV 01) � ADDRESS: —NM C t
I''t am requesting that the above permit be renewed. I
understand that I must schedul nd 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 C `^ C GA �6 Aa Q �4 � dG
OWNER/BLDR OR CONTRACTOR bI(jPVATbi9E
DATE
Print Name
STATE OF FLO�Ar f'
COUNTY OF — ,
ACKNOWLEDGED BEFORE ME THIS ` DAY OF 1 Y 0' 1 1 % 70 2
BY I � �( ---�-
WHO IS PERSONALLY KNOWN TO ME k OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FL Rl County of_ I�
SIGNATURE OF N Ry Tay►pl O'Sr!n
° NOTARy Pqq
~ STAT9 W 1Fi1,O%Rtl
r VX 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(%)] $175(pennit fee) x .65=$ ] 13.75 (renewal fee)
Revised 7/21R014