HomeMy WebLinkAboutrenewal requestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
00 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)4 -1 Fax 77 -1 7
PERMIT RENEWAL REQUEST
L HptTu Lk , 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,
understand that this is a (]NE TIME RENEWAL and the permit shad expire should I not receive a
passing inspection during any six month period during the renewal period.
JustificationAhL
4WNEX�R 4R CONTRACTOR SIGNATURE
Print Nance
STATE OF FLORIDA #
COUNTY OF 5�_ ), 1%� C.{ 4e
ACKNOWLEDGED BEFORE ME THIS 71 —
DAY OF
M
WHO I1
III
DATE
HAS PROVIDED AS IDENTTFICATION.
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STATE OF FLQRIDA, County of
SIGNA"E OF NOTARY
SEAL
-- _ . -__". T
Notary Pubkc State of Florida
Margaret E Montepare
My Commission GG 214990
Expires 06/05/2022
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FOR OFFICE use ONLY;
Number of Open Inspections;
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage-.
ri i nal permit fee; x % open = Renewal fee
Example: [15 dIVided by 23=.65(%)] S 175(permit fee) x .65=$ l 13.75 (renewal fee)
Revised 7/21/2014
4106 mob
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