HomeMy WebLinkAboutrenewal permit deer run.pdfPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
s BUILDING AND CODE REGULATIONS DIVISION
r r 2300 VIRGENIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: �%� —(D"Sy ADDRESS: 5 02 7 )e-O,�e—
I, �c-VYN0---N , am requesting that the above permit be renewed. I
understand that I must schedule 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 fie. c' r-O -�' C - Lk
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLW4D
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 30 DAY OF C( J2 � `�J 20 2\
BY eQQ- kw1 WHO IS PERSONALLY KNOWN TO MEO�� OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA, County of W`-�-C�i ip�►"4� Notary Public State of Flonda
Ashley Del To
r My Commission HH 052369
hoar. Expires 10/11/2024
SIGNATUIRE OF NOTARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
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