HomeMy WebLinkAboutPERMIT RENEWAL REQUEST,. _* 'IL dff
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
SCANNED
PERMIT RENEWAL REQUEST .St, `UCB C01117ty
PERMIT NUMBER:_ 16(7t' — G`i 0 [ ADDRESS: p O1 S PLA-n44-r 101') L11lee s DO
I, VOC-Pi1t Mi hWe 1 t i VI b , am requesting that the above permit be renewed. I
understand that I must schedule 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 Irenewal period. �1
Justification 021ed t� L)r-e-'-Im-2 d ia-P t� UYl�1-�r-s-2ei 1
OWNER/BLDR OR CONTRACTOR SIGNATURE
1y1C-ey)� ni►4YC-e11inp
Print Name
6-s,1g
DATE
STATE OF FL t .
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS_ DAY OF I 20�
BY]l�ph i( ,�l�f{ _WHO IsPERSONALLY KNOWN TOME OR
HAS PROVIDED �- I n t AS IDENTIFICATION.
STATE 9F FLOR41571, County
,REN S. NIELSEN
of Florida -Notary Publi
mission 0 GG 207484
FOR OFFICE USE ONLY:
Number of Open Inspections
Total Inspections:_
(Divide open by total % of open inspecti �s)� 5� %
Percentage:}/
Original permit fee: �%open = Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
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