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
i
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ��l�C/Lo /( 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 rnewal period•
Justification
i
I
O DR NT`RAACTTOR SIGNATURE D TE
Print Name
STATE OF FLORID
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 2
BY -WHO IS PE NAL Y I OR
HAS PROVIDED AS IDENTIFICATION.
OF T FLORID Coun of v�C, i,ram_.
'*lam
IG ATURE OF NOTAR = � tA%MNA��iiAN�RAH
;+r �"CftMIS3tON#Gf3275015WD
i0
Bw*d7ku P�Bctlndecvrruers ,
FOR OFFICE USE ONLY: w
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