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 ,P
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PERMIT RENEWAL REQUEST P .Od
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PERMIT NUMBER: 1811-0148
ADDRESS: 3045 NW RADCLIFFE WAY
1, A & G CONCRETE POOLS, INC. , 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 TEM RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period. S
Justification OWNER WAS BUILDING A POOL HOUSE AND WE COULD NOT COMPLETE �'A
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SOUR PROJECT UNTIL IT WAS COMPLETE
&ft rR/BLDR OR CONTRACTOR SIGNATURE
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Print Name
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DATE
STATE OF FL 1 n
COUNTY OF ICJ t ),�
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY r) G�iMPh T Li rib(, Y" I S PERSONALLY KNOWN TO ME OR
AS IDENTIFICATION.
TRACEY W. MCGHEE
NOTARY PUBLIC
a STATE OF FLORIDA
SEAL Comm# GG360070
Expires 8/10/2023
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 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
(Revised 7/2112014