HomeMy WebLinkAboutPERMIT RENEWAL REQUEST[qoA(- o t5(o
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
o BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 s
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PERMIT RENEWAL REQ pU 4o JBzvp 44.149
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APE T NUMBER: �Qyl r bl ADDRESS: 0,4,j btJ Ut a
'11k� iw l 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.
D0
OWNERR%//BLDR OR CONTRACTOR SIGNATURE
Print Name
STATE OF FLORIDA
COUNTY OF _ E+ LcA_.Gk
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DATE
ACKNOWLEDGED BEFORE ME THIS _ DAY OF �Q Q , 20-11�—
BY T)na tlkxl& . WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED rL D z AS IDENTIFICATION.
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 7/212014