HomeMy WebLinkAboutKleinPermitExtensionPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2-1 (D 2. LPAC-1)14 ADDRESS: 12-7-72- N h' VAY t n e r 07-
I> �� C , 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
O ER/BLD OR CONTRACTOR SIGNATURE
Print Name
STATE OF FLOAT, V
COUNTY OF
ATE
ACKNOWLEDGED BEFORE ME THIS 2(y DAY OF J LjL� 20 2-I
BY S CV(�( WHO IS PERSONALLY KNOWN TO ME 1� , OR
HAS PROVIDED AS IDENTIFICATION.
STATK OF FLORIIM, County of `440
ILA Eotary Public State of Floridangela StaplesSIGNA NOTARY Ay Commkssion GG 235102SEALxpires 07/04/2022
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=$113.75 (renewal fee)
Revised 7/21/2014