HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
• BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGI\YA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST Off, gY ED
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PERMTNUMBER: 170 4/4,16-7- Z ADDRESS: _ ZOa S. ZG1. ([� t I cwi ellt i3c g
u �U0 Inq" s� `� am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be fmaled. 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
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Pnnt Name
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DATE
ACY-N70/NVLE�DGED BEFORE MHI E TS �L DAY OF F 20 g
BY 17/rpr(Li2A� S CDS-tiL WHO IS PERSONALLY KNOWN? %�IBtnerr,,,,_ .OR
H.4S PROVIDED NC- o` [ 2%9 2Z POC.��'"_
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STATE frf% Counmor t�14? FE ia,r2 v�or �pRY e'
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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 = S Renewal fee
Example: .—[15-divided by 23=.65(°/n)] SI75(permit fee) x.65--S713.75 (renewal fee)
Revised 7212014
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