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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 GC MNED PERMIT RENEWAL REQUEST BY zat, LuCf co ov ERMITNUMBER: / i���©�J �., ADDRESS: `30t, `A I, C�-�CA- Lk 1 Z , 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 pa 1 sing inspection during any six month period during the renewal period. Ju �tification t o r,A- r ra caor ct i ro + In 6 0 Lj U lP O RBLDR OR CONTRACTOR SIGN tm DATE Pri t ame TE OF FLORIDA ;NOWLEDGED BEFORE ME THIS IV- DAY OF 20N % O IS PERSONALL KNOWN TO ME OR PROVIDED AS IDENTIFICATION. n .TE OF FLORIDA, County of OF OFFICE USE ONLY: ier of Open Inspections: Inspections: le open by total to get % of open inspections) SEAL $+�llpun o.19nd �oN tiV! ezaz 1800E NOISS�IdX3 ,;a...: �IN�� SIWW00,1{y =• it permit fee: x % open = $ Renewal fee dWfIH'B QOy ';; d ,fir= le: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee) 7/21/2014 _ `RFY 14UMPHREY ;#: �,' . �Ar. SSION # GG 300817 Pam€ ^IRES: �&tarch 6, 2023 By •:. a Nolay Pubk Unde mbm .