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HomeMy WebLinkAboutPERMIT RENEWAL REQUEST 2-5-20V I PLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982 -1553 Fax (772)462-1578 SGAN�F (772)462 BY St Ludeftl*PERMIT RENEWAL REQUEST l3 �I �[ ' � PERMIT NUMBER: `U ©�^ 0 6 / I� ADDRESS: 13 Z- S� �/�t/� �dl� 1�' 9 I, 13'e,.PF La K ? h r-t o , am requesting that the above permit be renewed. I understand that I must I<chedule 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 inspec 'on during any six month period during the renewal period. Justificati6 `' G o h f k-g c G'E- � A /oat h d ati- d FO—HOU J-e 7:elf g�g at Name 2 —_' .--Le 20 DATE STATE OF FLORIDA COUNTY OF ACKNOWLEDGED BEFORE ME THIS '5 DAY OF 20C J BYQ,iAC��rT�' I WHO IS PERSONALLY KNOWN TO ME ' OR HAS PROVIDED q�)jol AS IDENTIFICATION. STATE OF FLORIDA, County of CIA SIGNATURE OF NOTARY SEAL '2°a `6`�= ` f c �c•: Publi I °*��e (':or.' m1351ou v; GG 700 %q fViv Co:r;rni s�,, I FOR OFFICE USE ONLY: L--�� Number of Open Inspections: k star ofL-LAUGHTotal Inspections: C Florida_Notar N(Divide open by total to get % of open inspections) °mmission # yi'ubl MYCo slon#o G 270079 Percentage: October n Expires Original permit fee: x% open = $ Renewal fee22, 2022 Example: [15 divided by 23=.65(%)] i $175(permit fee) x .65=$113.75 (renewal fee) Revised 7/21/2014