HomeMy WebLinkAboutTRINITY, G Renewal.pdfPLANNING 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 �(�aIOJ Oaga ADDRESS: 3O�-i (te 0J Jb.i f..
I, � A r r tr= DQk---XU i'-5 , 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.
Justificationmil.o6r cS no "f i ryUC+ e_ Mj � A
S �� X
OBWNERR R CONTRACTOR SIGNATURE
,.. krne S O Day #. S
Print Name
STATE OF FLORIDA
COUNTY OF PA ( rn
a`' - a0l
DATE
ACKNOWLEDGED BEFORE ME THIS DAY OF €�c'U(J r 1C 20/o�o�L
BY, -)Pi �,$ P • DCLU LS WHO IS PERSONALLY KNOWN TO ME ✓ , OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA, County of Pal rn-
o,�P(LV PUBli ANGEL.AYOUNG
_ c Commission # GG 968864
SIGNATCRE OF NOTARY SEA9t o Expires April 12, 2024
FOF Roe> Bonded Tbru Budget Notary Services
------_----"""-------""--______________________--___--"'"""----__
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