HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGMIA AVE
FORT PIERCE, FI. 34982
(772) 462-1553 Fax (772) 462-1578
oUH PERMIT RENEWAL REQUEST
BYY
;t I Iwip('rninty
PER MIT INTO MBER: /) ('SZ ADDRESS: r32.I6_ S, jAkt--Vtek CIt2 mod, Z,
v�--T A— os4- am requesting that the above permit be renewed. I
understand that T must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TEIAE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
DIV R O�7 CON'TRACTOR SIGNATURE
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print Name
DATE
STATE 0
COUNTY OF;
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ACKNOWLEDGED BEFORE TIE THIS 36k. DAY OF �0 L S
BY &Aa(x j t- op s fi. \VIIO IS PERSONALLY KNOWN TO ,NIE
.OR
HAS PROVIDED 1NC_ p(, l2Za(2'L
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FOR OFFICE USE ONLY:
R'OVEF
Number of Open Inspections:
,
ttlnnl 0_
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)] $175(pemtit fee) x.65=S113.75 (renewal fee
Revised 7212014
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