HomeMy WebLinkAboutPERMIT RENEWAL REQUEST® PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGIN7A AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
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6GANNED PERINIITRENEWAL REQUESTf I tlr13lY'
BY (»Intl
'it I_iwiarminty
PERMIT NUMBER: � 7� 6Ij Z ADDRESS: J z f0 S. V/GV+ C ilL RJr, 3
1, as-✓t't�s �` �0 s 'L� ti 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
DATE
l fat7.'[EF CgBol t".4
S'I'ATE OF FEMMA
COUNTY OF P49v KA-40VE/L
AC1CNOWLEDGEDBEFOREivirms,4- DAYOF Ll 20 I.R
BYCIn 19S C0TILI O WHO IS PERSONALLY KNOWN TO HIB OR
HAS PROVIDED i� jY-- IZZlZZ AS IDENTIFICATION.
Pe,a 61 cw?--tl.ta STATE or . County or I.kc7 I-4AivoVr�/C tL '•
FOR OFFICE USE ONLY: %•a,F/' COu`
•rnureum:nn�
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x %open = S Renewal fee
Example: [15 divided by 23=.65(%)] 5175(pennit fee) x .65=5113.75 (renewal fee)
Revised 7/212014 rq
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