HomeMy WebLinkAboutProject Information 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 �FCell.,,
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PERMIT NUMBER: 'SL C (9 ADDRESS: 12501 414 906'
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 eriod during the renewal period.
Justification e5;—( f (J�"° l�0 �di�/� - r2dv% -/-0
LDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF 5-"V.
ACKNOWLEDGED BEFORE ME THIS , DAY OF I`�o.y 2015
By -Z•S SC 1h u 1�'6' WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L L AS IDENTIFICATION.
STATE OF FLORIDA,County of +.L 10 C. ve ( p DEANNA GIVENS
Notary Public-State of Florida
` »• My Comm.Expires Dec 16,2016
SIGNATURE OF NOT Y =;�' �� SEDgpmission#EE 858761
Bonded Through National Notary Assn.
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FOR OFFICE USE ONLY:
Number of Open Inspections: Z
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ "1 S .bt Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014