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HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND CODE REGULATIONS DIVISION ® &1 1 Caw 2300 VIRGINIA AVE ----- -- FORT PIERCE, FL 34982 (772)462-1553 Fax (772)462-1578 SGANNED PERMIT RENEWAL REQUEST BY St. Lude County PERMIT NUMBER: / 6 ©L —O ZS7ADDRESS: (Jt3 6 O C S cDC—, V � I, g'�'X 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 g"C; /1, ►1CV�e-t Sid / �' � _ _ �dbzd1 -6 �! ZZ:D OWNERBLDROR RSIGNATURE DATE Print Name STATE OF FLORID COUNTY OF r�_u P o ACKNN+O�WLEDGE/D� BEFORE ME THIS _k DAY OF h-PAS 20 1^l BY WHO IS PERSONALLY KNOWN TO ME . OR HAS PROVIDED FOR OFFICE USE ONLY: Number of Open Inspections- 1— Total zin��� (Divide open by total to get % of open inspections) _ Percentage: Original permit fee: x % open = $ Renewal AS IDENTIFICATION. SEAL tP B'O LASHAHNAINGRAM • Notary Public - State of Florida = ; = My Comm. Expires Dec 20, 2018 �; o"" Commission # FF 177249 Bonded through National Notary Assn. Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee) Revised 7212014