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HomeMy WebLinkAboutPermit renewal PLANNING AND D VELOPMENT SERVICES DEPARTMENT - BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE FORT PIERCE,FL 34982 (7 2)462-1553 Fax(772)462-1578 PE IT RENEWAL REQUEST PERMIT NUMBER,\ 1 t9)1 \f ADD SS:�n�t <j \l l \1T Q - � fTt am requesting that the above permit be renewed. I understand that musts hedule and pass all requir d inspections for the permit to be finaled. Further, I understand that this is a ONE TIME RENEWAL ;nd the permit shall expire should I not receive a passing inspection during any six month period d ng the renewal eriod. Justification 'OVNERBLDR O &NATURE DATE h0\A 7�MUO) Print Name STATE OF FLORIDA COUNTY OF I - ACKNOWLEDGED BEFORE ME THIS DAY OF I ,20�� BY 1 WHO IS PE I NALLY KNOWN O ME ,OR HAS PROVIDED AS IDENTIFICATION:_ tegv"a�B: KRISTINE YUT C =°•`�1��= Notary Public-State of r"J�An STATE O F ORIDA,County of J� t Commission GG 2375 :9F_• My Comm.Expires Jul 11 {I Bonded through National NotaSIGNA OF NOTARY 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)I I.65=$113.75 (renewal fee) Revised 7/21/2014