HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGLNIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1579
J(;A YNED PERNUT RENEWAL REQUEST
`t 1 11riP (;OUgty
PERM[TNUMBER l U D,:;E2_X_ ADDRESS: 32.(Z S L4r)(: %I'ciJ cj+_ c u�13
t e�yl 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 1 not receive a
Passing inspection during any six month period during the renewal period.
Justification
OWNERBLDR OR CONTRACTOR SIGNATURE
DATE
A- 0)STI ,
Prmt Name
P00-114 cAa-t,etA
SPATE OF FtBRIBA
COUNTYOF Neft.:s (4,ANuv64
ACKNOWLEDGED BEFORE ,\1ETHIS _7O+`
DAY OF F 20 I
BY M7-�s G' t Tt.J
WHO IS PERSONALLY -
KNOWN , � �"rn+,ri
�O�' moo.. OR
HAS PROVIDED Mc- QL I'L79 2 -4.t)N.
hf0.7Tlk Cq i2l t oa
d
STATE OF-FLlbt7 r county of f >r lC' 1
SIG.
`5' GBLIG '+�'
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FOR OFFICE USE ONLY:
—
Number of Open Inspections:
Total Inspections:
N
(Divide open by total to en inspections)
get % of op
N J
V-
Percentage:
E
Original permit fee�ic oo open = $
Renewal fee
i
Example: [15 divided by 23=.65(%)] SI75(permit fee) x.65=SI 13.75 (renewal fee)
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