HomeMy WebLinkAboutPermit Renewal RequestPERMIT NUMBER:
PLANNING 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
1710-0544 ADDRESS:
7507 Sebastian Road
I Seven Kirby , 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 Financial
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OWNERBLDR OR CONTRACTOR SIGNAT DATE
Seven Kirby
Print Name
STATE OF FLORID
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF L p ✓ P,M)0Gr 20
BY Q `/ Q,n C j e b y F�-WHO IS PERSONALLY KNOWN TO MEOR
HAS PROVIDED AS IDENTIFICATION.
ST 0 LORID , Co of S i• L_%4G1 Ct ALEX DE SOUSA
a NOTARY PUBLIC
STATE OF FLORIDA
IGNA OF NOTARY" SEAL ? Comm# GG157288
0,00E M Expires 11/1/2021
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