HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT ,
J BUILDING AND CODE REGULATIONS DIVISIONUNTY
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. 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: S L C- 13 Oct O 3$s ADDRESS: 3 209 I n cln&-16 o.` 31
I, Al -,-�IO,sC K ,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 10t 6141cul am k-a iA Loys(ae-S;2 vfte^ '.
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OV7NEftLDR 01&eNTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLORIDA
COUNTY OF S7 .4 U C/E
ACKNOWLEDGED BEFORE ME THIS .3 DAY OF IUO V-^��2 2Q-�2 I_
BY 1/,420 G>/'O S C /? WHO IS PERSONALLY KNOWN TOME &I" OR
HAS PROVIDED oo AS IDENTIFICATION.
STATE OF FLORIDA,County of -Iomy7
NEIL FRANK
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Commission#HH05M
SIGNA RE OF NOTARY SEAS Expires December 3,2024
IS
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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)
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Revised 7/21/2014