HomeMy WebLinkAboutPermit Renewal RequestPLANNING 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
PFRMTT N1 TMRF.R- I % d � — 0 L _�'3 ADDRESS: )4C ' l elA, 01, I i• ' ' IC(r'e '-6
I, ;gjr'4�"� �ie�[/�G) , am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be f naled. 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 W ApVt cf^-) e le, A--c fd `Li t «der & 61nij
pyW DR OR CONTRACTOR SIGNATURE 5—ATff—
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STATE OF FLORIDA
COUNTY OF O
1 ACKNOWLEDGED BEFORE ME THISa, DAY OF '*1 p Q � 20 kt
BY \ \"\ WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED L L AS IDENTIFICATION.
TATE OF FLORIDA, County of S '� �+ 1�c •f,. a""'� "'d��`"''°'
DEANNA MARIE GIVENS
MY COMMISSION # GG 022023.
SIGNATURE OF NOTA13Y F ° ` EXPIRE,9fAFember 16, 2020
Bonded Thni Notary public Undemidters�
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