HomeMy WebLinkAboutProject Information PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Mm-r-reff RRi
Building and Code Regulations Division
• 2300 VIRGINIA AVE.
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUIRE/
._D SAN 191010
PERMITNUMBER: [ S n� ` ba(oa- ADDRESS: 810 S OG� jV �e if 1y3�
i, N(GI4PV, 6041N ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be fmaled. 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 f::b&b0T- `B UAIA- l NS(h,C,<t Of-) LMO►'L V I t
O RMLDR CON CTO NATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF SA•l.l�i c-'\e
ACKNOWLEDGED BEFORE ME THIS \d DAY OF 3 q Y1 ,20
BY �rd t4Ni:1 i `\ WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OFFLORIDA,County o . L J C "K P''-,,^ �DEANNA GIVENS
Notary Public-State of Florida Y
+ My Comm.Expires Dec 16,2016
S GNATURE OF NOT Spoltmission#EE 858761
Bonded Through National Notary Assn.
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(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 6/24/2014