HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
.r._.-.'..-_.-.- FORT PIERCE,FL34982
(772) 4621553 In (M) 462-1578 SC MYEL)
By
PERN HT RENEWAL REQUEST St. LUCia rnllnh
PERMIT RNUMBER: ADDRESS:_MIA& I44
I, n1_4 F)C(L�' UO i-P 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 WcE�,;Q 1,1 S fin a tj
4 'Z- F;_552- -_ c�—
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OWNERBLDR OR CONTRACTOR SIGNATURE/DATE
Print Name
STATE OF FLORIDA
COUNTY OFF
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ACKNOWLEDGED BEFORE METHIS
DAY OF �.:.1 .20A.
WHO IS PERSONALLY KNOWN TOME .OR
HAS PROVIDED
FLORIDA,
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
AS IDENTIFICATION.
SFAL
Example: [15 divided by 23=.65(%)) $175(permit fee) x.65=$113.75 (renewal fee)
Revised 72I20I4
FEB 14 2018
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