HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 RECEIV ED
(772)462-1553 Fax (772)462-1578.
SCANNED ro�� 0 8 i018
PERMIT RENEWAL REQUEST
& Lucie Cou I ST, Wcic County, Permitting
PERMIT NUMBER: ADDRESS: 1 �P ���b!L 1
I, em%dtij d , 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 month period during the renewal period.
Justification ' P�,,7 4- N-D4— G /o" 6j -"
OVINER/BLDR
cz "
Print Name
11Q/q
DATE
STATE OF FLORID
COUNTY OF
ACKXQWLEDGED BEFORE ME THIS _� DAY OF LO V J20�_
BYDM—,'1U0WHO IS PERSONALLY KNOWN TOME , OR
HAS PROVIDED AS IDENTIFICATION.
STATE 0 0 C� of i
SIGNATURE OF NOTARY N
KAREN S. NI
1►A B!
State of Florida -Notary Public
•= Commission # GG 207484
91 ��io�wro`��-� ••r 'June 12, 2022
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage: r
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