HomeMy WebLinkAboutPermit renewal formPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
LORI 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2001-0386 ADDRESS: 5003 Sunset Blvd
1, , 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 Covid-19
�NERJBLDR OR CONTRACTOR SIGNATURE
W. Bryan Adams
Print Name
STATE OF FLORIDA
COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS 26
BY W. Bryan Adams
HAS PROVIDED
STATE OF FLORID County of St Lucie
0
SIGNATURE OF NOTARY
FOR OFFICE USE ONLY:
5/26/2021
DATE
DAY of May 2021
WHO IS PERSONALLY KNOWN TO ME X . OR
AS IDENTIFICATION.
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x %open = $ Renewal fee
�ft Notary Public Stale d finds
Hannah E Moore
S gyq� 1 My COr1lrl IUM M 017009
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Example: [15 divided by 23=.65(%)] $175(permit fee) x .65 $1 13.75 (renewal fee)
Revised 7l21.7014