HomeMy WebLinkAboutMisc Letters 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
PERMIT NUMBER: L Cd�UG ADDRESS: O '�a 6.6/rk 0 S /T` PS/-
,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 `U k S"a C 7'(- 0,& P/.v 1 O.v-e QAZ 1104a r PG
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OWNERIBLDR OR COON-TRACTOR SIGNATURE DATE
'�veC-h/Ie,
Print Name
STATE OF FLORIDA
COUNTY OF \-k
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
By �' �� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED L AS IDENTIFICATION.
STATE OF FLORIDA,County of ��'�'�C
Ng S,Ot4# N.=
\J }'�"�Sti'•; My OpMMISSION iI GG 022023
pewmber 1S,2020
SIGNATURE OF NOTAR =°. f Sot,1qtaryPublkUndewbfs
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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