HomeMy WebLinkAboutPermitRenewalRequest 2844 Harson Way Fort Pierce StuccoPLANNING 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: _____________________ 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 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
___________________________________________________
Print Name
STATE OF FLORIDA
COUNTY OF _____________________
ACKNOWLEDGED BEFORE ME THIS ________ DAY OF ______________________________, 20_______
BY ______________________________________ WHO IS PERSONALLY KNOWN TO ME _________, OR
HAS PROVIDED ________________________________________________________ AS IDENTIFICATION.
STATE OF FLORIDA, County of ________________________________________
_____________________________________________
SIGNATURE OF NOTARY SEAL
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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