HomeMy WebLinkAboutRenewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERNUT RENEWAL REQUEST
PERMIT NUMBER: Z�.0 �3--%6I 0 ADDRESS:
` �F-1 .
I, �) 00\..VA C�,C. , 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
OW rgtRBLDR OR CONTRACTOR SIGN TURE
J�ct S, C�
Print Name
-Z;• 2v2z
DATE
STATE OF FLORIDA �4. �� ;
COUNTY OF l' �j
ACKNOWLEDGED BEFORE ME THIS DAY OF a�C T" 20 C"
LZ
BY OWHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED AS IDENTIFICATION.
STATE Q)E FLORIDA,
SIGN
SEAL
FOR OFFICE USE ONLY:
.;�',pY PU •••, _WREY B. HUMPHRF
Number of Open Inspections: _ �P " MY COMMISSION # GG3 023817
Total Inspections: t' ' EXPIRES: March 6,
(Divide open by total to get % of open inspections) "•'.FgFF;°a' BondedThruNotaryPubfi°Unde�wri
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