HomeMy WebLinkAboutPERMIT RENEWAL REQUESTft
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_ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
w BUILDING AND CODE REGULATIONS DIVISION
COUNTY
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 RECEIVED
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BY PERMIT RENEWAL REQ ST JAN 2 3 21319
ST.ucjt$StLcieCdnty Lie Coui
PERMIT NUMBER LC D D � ADDRESS:
( Y
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
I
STATE OF FLO A
COUNTY OF .
ACKNOWLEDGED BEFORE ME THIS DAY OF q Y1 .20
BY 3% Q V\ 4 Q WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED 1 Q L'I AS IDENTIFICATION.
TATE OF FLORID,, County of S I �—v C \ -- 'I.,
DEANNAMARIE GIVENS i'''
COMMISSION 0 GG 022023
SIGNATURE OF NOT ^ Y "•�M' EXP Decembt3r 16, 2020
gp•' Bonded t�' otary Public Undetw&sr.
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % Ppen = $ Renewal fee
i
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014