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PLANNING AND DEVELOPMENT SERVICES IDEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 j RECEIVED
MAR 2 5 2022
PERMIT RENEWAL REQUEST
St:.6ia010 County
Permitting
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PERMIT NUMBER: 2J®l-(/ 1 ADDRESS: / � Oyk-SvV //y�
I, ,am requesting that the,above permit be renewed. I
understafid that I must schedule and pass all required inspections for the permit to Ibe 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 rO PI-01,4r' i f li L! 1. lVQae—ff AIZ- Crary,
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OW R/l3 DR OR CONTRAC OR SIGNATURE DATE
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STATE OF FLORIDA
COUNTY OF
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ACKNOWLEDGED BEFORE ME THIS �S DAY OFF r 20 a3_
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BY hrS_� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED T L �+�' AS IDENTIFICATION.
STATE OF FLORIDA,County of S L U c c DEANNA GIVENS
:r• �: Notary Public State of Florida
9 0` Commission g HH 086359
SIGNATURE OF 96TARY ''•'�oF�Q` My CoMAExpires Jan 28,12025
Bonded through National Notary,Assn.
FOR OFFICE USE ONLY:
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Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
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Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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