HomeMy WebLinkAboutPermit Renewal RequestT
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER-. loll 10 .00,
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BUILDING AND CODE REGULATIONS DIVISION
2300 vIRGnMA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
ADDRESS-. S532
14e,
am requesting that the above permit be renewed. 1
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.
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STATE OF FLORI�4 f `
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ACKNOWLEDGED BEFORE ME T111S
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AS PROVIDED
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WHO IS PERSONALLY KNOWN TO ME OR
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AS IDENTIFICATION.
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Mir rr;rian GG 221434
SfGNAfRE OF OTACRY Ex p � res P, a,
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ti-
ointy of
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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(%)] $175(permit fee) x .65=$X 13.75 (renewal fee)
Revised 1 1