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HomeMy WebLinkAboutPermit RenewalPLANNING 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: 5 LC i (PO),-OOO ADDRESS: I � 50 & rY � s� L-4 I , 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 %q eil &%1j L F-ok FIAJAL -;r/USPEL'Tioti -)©46 AC.Tnu.rYGNATURh DATE -TO'?r 1, Print Name STATE OF FLORI�D�A� �/ / COUNTY OF po)-M 6&4 ( ACKNOWLEDGED BEFORE ME THIS /✓ `' DAY OF f 06 20 16 BY A�or WHO IS PERSONALLY KNOWN TO ME <� , OR HAS PROVIDED` �� X/Va S l j AS IDENTIFICATION. STATE OF FLORID ounty of SICNATURE OF NOTAR 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 4V spears HeatheCOMrw� #M4 93 SEA EVRE& June 21, 2019 www.AAAONNOTARY.COM Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee) Revised 7/21/2014