HomeMy WebLinkAboutPERMIT RENEWAL REQUEST11 two ��zg'
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE ✓ AFC
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 S�¢�'9y2s FQ
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PERMIT RENEWAL REQUEST
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PERMIT NUMBER: I D U �V 0()-7 ADDRESS: 3 3 0 ORa,�9 �¢�FRT Oc�✓c�.
I, ST/f,✓ /��c-/..✓ am requesting that the above permit be renewed. I
understand that 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.
OWNER/BLDR A CONTRACTOR SIGNATURE DATE
Print Name /
STATE OF FL0 DA
COUNTY OF Ct I t'Yl _
ACKNOWLEDGED BEFORE ME THIS DAY OFJ:Q Q
IM
HAS PROVIDED
SCANNED
BY
;r. Lucie County
20L9—
IS PERSONALLY KNOWN TO ME)— OR
STATE OF FLORIDA, Countyof Pq I m e eOC h
SIGNATURE OF NOTARY
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 = $ Renewal fee
AS IDENTIFICATION.
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014
Notary Public State of Florida
Theresa Ann Fermsi
My Commission GG 2408a4
Expires 07222022