HomeMy WebLinkAboutPermit renewal Greenbrier 2021-4-22 11.37.10PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
,COUNTY
2304 VIRGINIA AVE
FORT FIERCE, FL, 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2-00Y_ 2-i(a0 ADDRESS: I u-7 a
I, _ ,� S (7:-Lt2 -Q-fZ __, 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
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CONTRACTOR SIGNATURE
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Print Name
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DATE
STATE OF FLO
COUNTY OF 1 AC OWLEDGED BEFORE ME THIS q DAY OF j 20 It
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BY WHO IS PERSONALLY KNOWN TO ME V OR
HAS PROVIDED
ATE OF FLORSAo my of .
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FOR OFFICE USE ONLY:
AS IDENTIFICATION.
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Lauren Brusa[i
MY CommFssron GG 166770
I?of, Expires 1200'2021
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
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