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 J V-mlYNe®
PERMIT RENEWAL REQUEST r ! I (`iq COU17
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PERMITNUMBER:' v `L� �' ADDRESS: M LA-1t�
I, :�' �_ � W �—) o am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be fmaled. 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 js1: —Y] -IF I a. Al_ 1 r sp� GLUS�
OWNER/BLDR OR CONT CTOR SIGNATURE D E
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Print Name
STATE OF FLORIDA
COUNTY OF _ / "Q
ACKNOWLEDGED BEFORE ME TFIIS � `T DAY OF �JQI .20_L.
COME OR
AS IDENTIFICATION.
SEAL
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(0/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/112014 TMTM ry�yp��
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