HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-]553 Fax (772) 462-1578
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PERMIT NUMBER: l 8y g - a `{ Z-9
PERMIT RENEWAL REQUEST
ADDRESS: 30 s-6 1V W sack t `T'7- 61 4
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
OWNER/BLDR( OR C(ON)TRACTOKSIUNAIUKc
IAi UCH.{ A (J.e-t v,�
Print Name
6A
DATE
STATE OF FLORIDA,.
COUNTY OF �7` /_ L I.-e" f
ACKNOWLEDGED BEFORE ME THIS �`' DAY OF / , 201_
t
BY rC'� '� �� r�Q..h �} ^..WII0IS PERSONALLY KNOWN TO ME�1 Kja o//j���!
HAS PROVIDED AS
G� SST 7?°i
STATE OF F.LOR A, County of .Y
SEA ra`l-6u, ed iht ���!, 'pF` 4
SIGNATURE OF NOTARY - s��r�/ C urideQ. � \,`\
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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 % open = $ Renewal fee
Example: [15 divided by D=.65(%)I $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014