HomeMy WebLinkAboutPermit Renewals PLANNING 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: C)�^ ADDRESS:
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 an six month period duringthe renewal period.
Justif cation (4 I 1C lt�I i I-1 t- /,j i6e
�DR OR CONTRACTOR SIGNATURE DATE
t dvx FD(Yjw►�,
Print Name
STATE OF FLORID
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OFAAA:Y= 20—j--4
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �L n �. AS IDENTIFICATION.
STATE OF FLORIDA,County of (.( c
o�°""""e ELLEN VAD
SIGNATURE-UP NOTARY S l a State of Florida-N
=* *_ Commission # GF RQ'"`� My Commissionn1������_ October 22�
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