HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUII DING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL34982
(772) 462.1553 Fax (772) 462-1578 SCANNED
BY
PERMIT RENEWAL REQUEST St• LU(,'iP rnnntt.
PERMIT NR:' �ADDRESS: KA I/L I`Y'1" '`
I, Qvy Rd_z4g ) W 49 am requesting that the above permit be renewed. I
and tsre and tFrat 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 h-� -e I OL I tusQ Sr f [o.� �2-
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_GWITER/BLDR OR CONTRACTOR SI NATURE �AT
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Paint Nam
STATE OF FLORIDA `
COUNTY OF Q
ACKNOWLEDGED BEFORE METHIS DAY OF—Ciyly, 20
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED dr AS IDENTIFICATION.
STATE OF ORIDA, Countyoff
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•`i?' Ry_ AUDHEYa.HU774Y772
+; M1r7COMMISSION
.iEXPIRES: MarcSICNA OF NOT SEAL '?''aoMetl ThmNotaypy
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: [15divided by23=.65(%)I$175(permit fee) x.65=$113.75 (renewal fee)
Revised 721/2014
FEB 14 2018