HomeMy WebLinkAboutPermit RenewalsF_rt
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-COUNTY
L . O R I D F,
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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
PERMIT NUMBER: 2102-0595 ADDRESS: 8589 S US 1
ICI .
I, EDWARD LOU,,DRBACK , 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,l
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 NEED TO FINAL
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3/24122
I OWNERBLDR OR CONTRACTOR SIGNATURE DATE
EDWARD LOUDERBACK
Print Name ld
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STATE OF FLORIDA {
COUNTY OF � Lutc. i,t--
ACKNOWLEDGED BEFORE ME TH�ISy 2-14 DAY OF 1" 6LrCrl . 20 2 Z
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BY lIJ� N(i �(� LOLti je- act WHO IS PERSON 4LLY KNOWN TO ME , OR
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IiAS PROVIDED I. T AS IDENTIFICATION.
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STAT F FLORIDA, Coun ' F fpv`'op KR1STiNA L LOUOER3ACK
Notary Public - State of F.orida
/ Commission # qH 1528ta
GNATURE OF NOTARY SE o ff; My Comm. Expires Aug 7. 2025
Bonded through National Notary Assn.
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FOR OFFICE USE ONLY:
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Number of Open Inspections:
Total Inspections: I 'I
(Divide open by total to g tl ° o of open inspections)
Percentage:
Original permit fee: I i x % open = $ Renewal fee
Example: [15 divided by,23=.65(1/o)] 8175(permit fee) x .65=S113.75 (renewal fee)
Revised 712112014
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