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 RECEIVED
PERMIT RENEWAL REOU�ST APR 2 4 2018
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PERMIT NUMBER: ' fl i b ` ADDRESS:
1, t 1 aU" 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 in th period during the renewal period.
Justification %`75r �� ,
O ER/BLDR OR CONTRACTO SIGNATURE
R C l; A'-X I /\' Ltv fI
Pr t Name
STATE OF FLORIDA
COUNTY OF S'F L G t 'e
.//--Z, �' // i - -
ATE
ACKNOWLEDGED BEFORE ME THIS �_ DAY OF C5� Q �,� 20- L-4_
BY �c �d � t -f ^ v,% Cj 1\ WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
ATE OF FLORIDA, County of
TURE OF
FOR OFFICE USE ONLY:
coda Y ok�; DEANNA MARE
GIVENS
MY COMMISSION # GG 022023
EXPIRES: DSMbl,16, 2020
Bonded Thru Notary Public Undewritars
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