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
OUANNED PERMIT RENEWAL REQUEST
BY
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PERMITWiv1BER: UYO`SI % ADDRESS: S, 1 ctt/�c.✓iGyJ C I& '3
I' "� 5 t1 ' am requesting that the above permit be renewed. I
unde Stan that 1 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
0 W 1`B LDR OR CONTRACTOR SIGMA
DATE
Print Name
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STATE OF
COUNTY OF 2rL
ACKNOWLEDGED BEFORE ME TIBS � DAY Or -TC"'� 70 ( Q
BY ��
tqt eS. f-��'a jt t/L WHO IS PERSONALLY KNOWNTO MF.�nm�m:,._ nu
IIAS PROVIDED t-JC. UJ
E%itS CAA-C..L /--A � 'r
STATG O ounty of 1�U o
SIGNAM,t0
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Dig ide open by total to get % of open inspections) Lu
Percentage:
Original permit fee: x 90 open = S Renewal fee
Example: [15 divided by 23=.65(%)] S I75(permit fee) x .65=$113.75 (renessal fee)
Reviud 7/2 V2014Lofm
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