HomeMy WebLinkAboutPermit Renewals P0#-o1a7
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PLANNING AND DEVELOPMENT SERVIC;�.. -PARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
Nov 1. 9 2010
PERMIT RENEWAL REQUEST Permitting p�partment
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PERMIT NUMBER: � �L '®1 ADDRESS: I K��
I, ,am requesting that the above permit be renewed. I
understand at rrfidst sc e use an 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 '
1-4
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0 LD OR SIGNATURE DAT
rmt Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE+ME THIS _DAY OF �0Q\-I 20_ _
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L .� AS IDENTIFICATION.
STAT bJFZ�ORIDA,County of 5'�-Luc c((=
L �`"" ELLEN VAUGHN
SIGNATURE OF NOTARY SEAL `�c "Y P°°�'";_/��:State of Florida-Notary Public
y�lJ, Commission # G,G 270079
My Commission Explros
October 22, 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(perniit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
;�P;;e�, ELLEN VAUGHN
r ;State of Florida-Notary Public
=• Commission #GG 270079
%,I�,.�P p`OP��� My Commission Expires
October 22-2Q22...