HomeMy WebLinkAboutMisc Letters BANNING AND DEVELOPMENT S,__.,VICES DEPARTMENT
Building and Code Regulations Division
• 2300 VIRGINIA AVE.
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: r 5d '8 91 ADDRESS: '\ \
I, am requesting that the above permit be renewed. I
understand that I must sched a 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
-A
OWNETk"1_11K110NTRACTOR SIGNATURE DATE
Print Name {
JAN /8 2016
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS���DAY 20��
BY � WHO IS PERSONALLY KNO TO ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE LORIDA,Cou ty o7
,SIGNATURE OF NOTARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections: -1 5 6 a
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Y►�
q:�:•.va�• SUSAN MAGEE
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee) _ t+= MY COMMISSION Y FF 187647
a EXPIRES:February 23,2019
Bonded Thru Notary Public Underwriters
Revised 6/24/2014