HomeMy WebLinkAboutRENEWAL REQUEST PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
` BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2cb3' l)2570 ADDRESS: "*`C& IJ AA4
I, AI''Yl'1 alid o R &s 7&/e ,am requesting that the above permit be renewed. I
understand that I mus schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TI [E RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification LJ l�J2YCL r S %��
OWNERBLDR OR CONT CTOR SIGNATURE DATE
X ma4ldo g,9,�J" al2c1a
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEF ME THIS off- DAY OF �Ge!/ 20�
BY /A�i WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED / AS IDENTIFICATION.
STATE OF FLORID o unty of'--�%• Z6 /e RU1H1:LOPEZ
,.4 ICYCOMMMION#GG 294971
SIGNA 0 TARY SEAL '' eAr EXPIRES:J&nwq 24,2029 r
BOn WT1WUNftPubAeL%Ww ewrs
FOR OFFICE USE ONLY:
RUTH L.:LOPEZNumber of Open Inspections: -.; � WCOMMISSIO294011Total Inspections: EXPIRES:Jan ,2023(Divide open by total to get%of open inspections) ,, Bons UwNoWndwWfts
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee) RECEIVED
Revised 7/21/2014
O Lucie County
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