HomeMy WebLinkAboutPERMIT RENEWAL REQUESTo 3
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
]BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA. AVE
FORT PIERCE, FL 34982 &G N E®
(772) 462-1553 Fax (772) 462-1578
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PERMIT RENEWAL REQUEST
PERMITNUMSER: 0 () �--Q 13 ADDIIESS: ,�3409 &04-Ro-e- �c' �ElRvCQ
.I, V( C.VnWJ :]— N Q,W0A y , am requesting that the above permit be renewed. I
uuderstand'that I must schedule and pass all requhQd inspections for the pemit to be (waled. 1~urther, 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 KI D A.) loak-s-e- Un o --Q-( r : / sk -,- -A i P,G�
OR CONTRACTOR SXGNA.TURB
Print Name
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DATE
STATE OFF . ` �C[t
coUNTx of dl.. �� ff� r- C�
ACKNOWLEDGED BEFOU ,ME TMS DAY OF L`-A Q _re-h . 20 'I
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BY O'k, 1 Q,P�1 �J I V Q, ,�i WF[O IS PERSONALLY KNOWN TO ME
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HAS PROVIDED
.AS IDENTTI?'1CATION.
rP Notary public State of Florida
Francene Newman
SIGNA OF NOTARY SEAL My Commission GCS 221434
o� axpi_.05/23l2022
9
FOR OFFICE USE ONL*V:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit ;fee: x % open = $ Renewal fee
Example: [15 divided by 23-.65(°/u)] $175(pew3it fee) x .65=$113.75 (renewal fee)
Reviwd 7121014