HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
o BUILDING AND CODE REGULATIONS DIVISION
-----------._ 2360 VIRGIPIIAAVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772)462-Is78
SCANNED PERMIT RENEWAL REQUEST
BY
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PERMIT NUMBER L7U �fO S/ S ADDRESS: 3 2 ! (a . gyy�w L' I1�
I' c�✓ �5� "L . 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 TALE RENEWAL, and the permit shall expire should T not receive a
passing inspection during any six month period during the renewal period.
T,. r..__..-_
DATE
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P"4-4 IA&.0fI'tA
STATE or
COINiY OM -Ea vw�b✓ctL-
i
ACKNOO�W-�L��EDGE��D BEFORE NM THIS -•5_ DAY OF
BY—(kktnn�S (ne 741L, -20
WHO IS PERSONALLY KNO WN TO ME OR
HAS PROVIDED %T C- QL 12��j22
{� z TICnnor
STATE .,y. ,.r lo. 1(n.•�..n .. _e``S ��. .O hrA
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get °/a of open inspections)
Percentage:
Original permit fee: x %open = S Renewal fee
Example: _ [15 divided by 23=.65(%)l S175(permit fee) x .65=S113.75 (renewal fee)
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