HomeMy WebLinkAboutPermit RenewalsPLANNING 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:1 O ADDRESS: a?H o3 aV� Jai
I, �C\V �1,� r1 C� , 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 .
OWNER/BLDR OR CONTRACTOR SIGNATURE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF
HAS PROVIDED
STATE OF FLORIDA, County of
SIGNATURE OF NOTARY
FOR OFFICE USE ONLY:
)aioiaca►
ATE
20
WHO IS PERSONALLY KNOWN TO ME , OR
N
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
AS IDENTIFICATION.
SEAL
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014