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