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
RECEIVED
PERMIT RENEWAL REQUES1S'r—*'u_c"e
NOV 0 7 '19
Co
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PERMIT NUMBER:., Iy ' 03 / 7_ ADDRESS: Z(O G L(k C if—
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1; I) i ( n g��Z 2 , am requesting that the above permit be renewed. I
understand that 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 ,C% o/► e N
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OWNER/BLDR OR CONThACTORAIGNATURE
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Print Name
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STATE OF FLORI A
COUNTY OF •S • \..v �� ''__ ll
ACKNOWLEDGED BEFORE ME THIS , DAY OF oV 120 1
BY WHO IS PERSONALLY KNOWN TOME OR
HI S PROVIDED �F L L AS IDENTIFICATION.
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STATE OF FLORIDA, County of � 'r - FrA�,
- I pEgryNgMARIE GNEN5
MY COMMISSION # GG 0?2023SIGNATURE OF NOT Y PE�.L�PIRES: December 16,2020
.• onded Thru Notary Public Underwriters
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
Exi ample: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014