HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERNHT NUMBER: 1 t'�3 _ GoZq cY ADDRESS: ,'G CP/4 IV, le)
am requesting that the abovepermit 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 expireshould I not receive a
passing inspection during any six month period during the renewal period.
Justification /-,Y A.,c, 14 h .)i.( T „-, cl GV—'
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OWNERIBLDR.OR CONTRACTOR SIGNATURE DATE I
A(,_0 r 1? 02
Print Name
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STATE OF FLORIDA
COUNTY OF S�— hl if
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ACKNOWLEDGE BEFORE ME THIS DAY OF 20
BY 1W'HO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED �,
�RZLC�Q' AS7 'DO.011• AS IDENTIFICATION. aM
' �pSHpNNA�NGR°`Florida.
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OF FLORIDA,County of ,,,,al'PUe�y. Notary pubNc es deo 20,208
=��.4��MY 0omm�ssion#FF�olac`l assn.
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FOR OFFICE USE ONLY:
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Number of Open In ectionsi-,
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage: O
Original permit fee: x%open = $ _Renewal fee
1
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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