HomeMy WebLinkAboutPermit Renewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERNUT RENEWAL REQUEST
PERMIT NUMBER: Z1e2- 06a12— ADDRESS: /� �7 GI ✓�G�����C I��C�
I, C ��P�d�i�4�oV , 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,
understand that this is a ONE THE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
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OWNER/13LDk OR 6ONf0iCTOfFSIGNATURE
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Print Name
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STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY IHOISPERSON ALL KNOWN TO ME V� OR
HAS PROVIDED '� AS IDENTIFICATION.
R0BERTJ.LOVVE
W COMMISSION # GG 913717
=j ,,•' EXPIRES. October 20, 2023
SEAL oR.f':'°� Bonded TAru Notary PubNc Uedentt6ra
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)
V
Revised 7/21/2014