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HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND•CODE REGULATION&DIVISION 2300 VIRGINIA AVE. FORT PIERCE, FL 34982 (772) 462-1553 Fax (772) 462-1578 PERMIT RENEWAL REQUEST PERMIT NUMBER: O u� ADDRESS: ✓ r/ N �` 1 I/ V o ©b R-b I, �&> S A 1 IPIC-- am un erstand that I must schedule and pass all requir understand that this is a ONE TIME RENEWAL passing inspection during an,�/si�x,month period du: Justification L V 141,p ei ll h - WNERBLDR OR C NTRACTOR SIGNAT Print Name requesting that the above permit be renewed. I ,d inspections for the permit to be finaled. Further, and the permit shall expire should I not receive a •ing the renewal period. er ZIVA -S nOr /kv DATE STATE OF FLORIDA COUNTY OF ACKN ED ED BEFO THIS // DAY OF \� , 20 0a BY O TV PERSONALLY KNOWN TO iVIE OR HAS PROVIDED �1 D AS IDENTIFICATION. P OF.FLORIDA, Comty of SIGNATURE OF FOR OFFICE USE ONLY: SEAL Number of Open Inspections: ANGELA M HUFF Total Inspections: ,o�"0.YP`°° p �_ ,� „��-, Notary Public -State of Florida , (Divide open by total to get % of open inspections) * ' _ Commission # FF 234730 Percentage: %�9. P My Comm. Expires May 27, 2019 Original permit fee: x % open = $ Renewal a %° ��� Bonded through National Notary Assn. Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee) Revised 7/21/2014