HomeMy WebLinkAboutMisc Letters _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
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2300 VERGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: G 9-09" / ADDRESS: f
I, -Z; X� ,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 �'� AAA✓ O&—f— '5;-
OWNERLDR OR CONTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLORIDA
COUNTY OF yi�- AA-C"14
ACKNOWLEDGED B RE ME THIS DAY OF 20
By WHO IS PERSONALLY OWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
TATE OF FLORID County of La'..'a
ANGELA M HUFF
otary PublicState of Florida
SIGNATURE 0OTARY commission#FF,234730
a�comm.
ed ttrau�'res National May 27,20
2019
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(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014