HomeMy WebLinkAboutPERMIT RENEWAL REQUESTFEB-20-201B 09:49 From:
To:4621578 Pa9e:P6
PLANNING AND DEVELOPMENT SERVICES DEPAR s NT
9 " BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-t578 map �.3
%
o(ANNED
PERMIT RENEWAL REQUESTBY
PO,
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PERMITNUMSER: /706— Oe179 ADDRESS:_, LEY3S-1T'5at2klt�u4—Pe.�1ES C,"QO
am requesting that the above permit be renewed. I
understand that P must schedule and pass all required inspections for the permit to be £mated. 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 _ 1 9, S ,U ps A . s r ik az a�fbSri 4 k r r1�4
OWNERU)R OR CONTRACTOR SIGN
BA'111RE
Print Name
STATE OF FLORIPA
COUNTY OF ,_ vl-1C 1'
ACKNOWIT..DGED BEFORE ME THIS —_^ DAY OF
HAS PROVIDED
STATI: OF FLORIDA. County of skit It- -„
SIGNATURE O NOTARY
FOR OFFICE USE. ONLY:
Number of Open Inspeotioas:
ToW1 Inspections:
(Divide open by Total to get % Of open inspections)
Percentage: -
Original permit fcc: . x V. open = $ . _Renewal fcc
-rs-1r
DATE
OR
AS IDENTIFICATION.
TIMAOTNY W. W"0H
NOTARY PMW
WATE OF FLOR1OA
CaririFFlO4S11 �
Exp{res 3rlO12016
Example: 115 divided by 23-.65(%)l $175(pennit fce) x .65=S113.75 (renewal fee)
Rerind 7/21/2014