HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
7-10 E
Q BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PE IT NUMBER: ��oy 1'00°l a ADDRESS:
^T
I, CL1reGv et r am requesting that the above permit be renewed. I
all required inspections for the permit to be finaled. Further I
understand that I must sc dule and pass q p p ,
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 - 'l�n
/
O R/BLDR OR CONTRACT R SIGNAT DATE
rint Name
STATE OF FLORIDA t
COUNTY OF �C-A
ACKNOWLEDGED BEFORE ME DAY OF UU I� 20
BY 0 PE ONALLY KNOWN TOME OR
HAS PROVIDED AS IDE
ANGELA M HUFF
. State of Florida
STATE OF FLORIDA, ounty of ,��A.4 P''19e"- Notary Public
. FF 234730
Z. * * Commission# 27 2019"
My Comm.Ex ires May Assn.
SIGNATURE OF OTAR TF OF F`�p`,� Seed throng ational NTo �y kl
-', h N
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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=$113.75(renewal fee)
Revised 7/21/2014