HomeMy WebLinkAboutInspection Docs 772-770-0064 ARS 22:26:11 01-04-2000 1/2
PLANNING AND DEVELOPMENT SERVICES 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: I J " C ��% ADDRESS:
I, l;f=(1 hi S 7 L tL'e ,.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.
Justification Cli-e' f 4S L-k--eh up norf h • { r� -�v� 0.Yt
OWNERBLDR OR'CONTRACTOR SIGNATURE DD TE
Print Name
STATE OF FLORID
COUNTY OF C•I �-
ACKNOWLEDGED BEFORE ME THIS DAY OF
BY le-on i 5 ��-��-�� WHO IS PERSONALLY KNOWN TO ME��OR
HAS PROVIDED AS IDENTIFICATION.
7WTF F ORIDA, •oUY,ty
BETH A DERBY
SI RE OF NO TRY MY COMfi SIGN#FF220930
EXPIRES April 15,2019
inc7�39:0153 Flordallo:ey$e—ce.=m
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
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014