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Permit Renewal form
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND CODE REGULATIONS DIVISION • 2300 VIRGI NIA AVE FORT PIERCE, FL 34982 (772) 462-1553 Fax (772) 462-1579 PERMIT RENEWAL REQUEST PERMIT NUMBER: C C% () C( ADDRESS: 38 Sovereign Way I, Michael Flaxman understand that I must schedule and pass all required inspections for the pert the mit o be finaled. ed. I understand that this is a ONE TIME RENEWAI, and the permit shall expire should I not rec Further, I passing inspection during any six month period during the renewal period. elve a Justification house is being built,.We cannot install generator yet h b �-( DATE Print Name STATE OF FL A COUNTY OF ( >� ACKNOWLEDGED BEFORE ME THIS � {J`� BY DAY OF WH S PERSONALLY KNO p ME HAS PROVIDED , OR AS IDENTIFICATION. ATE OF FLORIDA, County ©ANIELLE GONCAUI—ES MY Cbk1-'j11SSi0N # GG 232946 EXPIRES: June 27, 2022 )nded Thru 001Zary Pcbiic UndcrwMers FOR OFFICE USE ONLY: Number of Open Inspections: Total Inspections: (Divide open by total to get % of ope Percentage: n inspections) 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