HomeMy WebLinkAboutRENEWAL REQUEST PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ADDRESS: 4469 jv &y- 1714
I, rriO-vidO ;?d- 0 ,am requesting that the above permit be renewed. I
understand that I must khedule and 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 � G"6-ac�0v-- / k6&ndt
GI o e? ,,
OWNER/BLDR OR CONT CTOR SIGNATURE ATE
' o1 .7 �
Print Name
STATE OF FLORIDA
COUNTY OF �5% P
ACKNOWLEDGED BEFORE ME THIS /� DAY OFF�eGPi!'Y�B� 20=3 /
BY ;e� Gd'�!D WHO IS PERSONALLY KNOWN TO ME y OR
HAS PROVIDED / - AS IDENTIFICATION.
STATE OF FLORIDA,County of <551--- LG�G/P
c0r.. *sivI,it GG 294HI
SIGNA NOTARY SEAL •� .;J 0,t:-':January 24,20n
Barded Thru Notary Public UndenMl t
FOR OFFICE USE ONLY:
Number of Open Inspections: :iRt ,. THLLOPEZ
WCOMMUMIiIG02949N
Total Inspections: ,ag D�IRES•Jatlua�y24 2023
(Divide open by total to get%of open inspections) ? ;; ,�r• BardedTftN0tVyPub6c�
Percentage:
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 ,sOEIVED
pEC ® � 2021
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