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HomeMy WebLinkAbout1636568050_PicosRdPermitRenewalRequest~ltl!Jt@ t ~," --- COUNTY PLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND CODE REGULATIONS DIVISION FLORIDA 2300 VIRGINIA A VE FORT PIERCE, FL 34982 (772) 462-1553 Fnx (772) 462-1578 PERMIT RENEWAL REQUEST PERMIT NUMBER: JDl O -DY L,7 ADDRESS : 7900 P1 LO~ Q.d . I, HI Cha--rJ \I\) o.\droe 'clJ? reguestin~ that the above permit be renewed. I understand that I must schedule and pass all reqmred mspect10ns 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 Final Inspection oeeckd Print Name STATE OF FLORIDA COUNTYOF 4 l di~( ID E ACKNOWLEDGEDBEFOREMErHis 9 oAvoF ~a,embcc ,20~ BY .if llbue I -S-DsCfl1 ~o ldr'f WHo Is PERSONALLY KNOWN ro ME--~ oR HAs PROVIDED I)-{.,; er I ; c eo<.::c ,, ;• ... ,~ounty of S.f-1 L(.)()c.. FOR OFFICE USE ONLY: Number of Open Inspections: __ Total Inspections: ____ _ (Divide open by total to get% of open inspections) Percentage : ______ _ Original pennit fee: ____ x % open = $ ____ Renewal fee AS IDENTIFICATION. SEAL ···~~~~·.~;·•... FERNANDO BETANCOUR'. /jrn·:,,~ •\ Notary Public -State of Florida i •. ! .Al, .:.i Commission 11 GG 194040 \· • .,., 2 f~rc,.-;:f' My Comm. Exp ires Mar 11 ,202 .......... ··80 ndcd through National Notary Assn . Example : [15 divided by 23=.65(%)] $175(pennit fee) x .65=$113.75 (renewal fee) Revised 7/21 /2014