HomeMy WebLinkAboutRenewal Permit requestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
PERMIT NUMBER:Z�ow -OddS - P.:
15 -1 cwit Lkmov-i .4.. &
2300 vI aGuvI-a AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT R-EN WAL REQUEST
ADDRESS:
P2
am requesting tha't the above permit be renewed. I
understand that I must schedule and pass all required inspection for p the permit to be finaled. Further, I
understand that phis is a ONE TIME RENEWAL and thepeIrTmitshall ex ire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
0
OWNER/BLDR OR
Print Name
STATE OF FLORIDA
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NTRACTOR SIGNATURE
COUNTY OF 7` A v
ACKNOWLEDGED BEFORE ME THIS 171h DAY OF
BY 1 U
HAS PROVIDED
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20
WHO IS SNLY &NOWN M R
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STATEFFLORIDA) County of � � ; rr
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SIG RE NOT R � F04*
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
AS IDENTIFICATION.
Fhubfic State of Fla
Logan M
My Commission HH 095437
Expires 2/2
(Divide open by dotal to get % of open inspections)
Percentage:
Original permit fee: x %open = $ Renewal fee
Example: [15 divided by 23—.65(%)] $175(perrm"t fee) x .65—$113.75 (renewal fee)
Revised 7 1 2 1