HomeMy WebLinkAboutPERMIT RENEWAL REQUEST-a )l�j 07-0 Vo-�
a PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
11 � C'! I ,
150141 BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
SCANNED (772) 462-1553 Fax (772) 462-1578
BY
C6, %
St. LUde CountV PERNUT RENEWAL REQUEST i'VIN.
PERMIT NUMBER:/70-7— 0 410-< ADDRESS:
1, 41 IV-4 c--/, -" . am requesting that the above permit be renewed. I
understand thg(t I 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
OWNER/BLDR,6R CONTRACTOR SIGNATURE
Print Name
STATE OF FLORIDAI
COUNTY OF 1� "1 19'2 C7C
ACKNO'VlLLEDGED BEFORE ME TFHS *7 DAY
WHO IS
HAS PROVIDED
HZ=
SIGNATURE OF NOTARY
FOR OFFICE USE ONLY:
DATE
2019
ME�OR
AS IDENTIFICATION.
y .
N-ouy Public State of Florida
Theresa Ann Femlsi
,,0fSEW0Mn1iW0n GG
NJ N. 240684
ExPlres 07r=022
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: _ x % open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x.65=$l 13.75 (renewal fee)
Revised 7121/2014