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HomeMy WebLinkAboutProject Information PI� °WING AND DEVELOPMENT SEL_.--1`CES DEPARTMENT BUILDING AND CODE REGULATIONS DIVISION • 1 ' A 2300 VIRGINIA AVE FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578 RECEI\Y'-D SES 2 1��6 PERMIT RENEWAL REQUEST PERMIT NUMBER: ) ®339 ADDRESS: 50©-7 (wa I, RPAP-r-l"GIC V19�� ,am requesting that the above permit be renewed. I understand that I must schedule and pass all required inspections for the permit to be f haled. 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 We Herz Ll�a,� Fy,hep,— �'p Qi-c �9D P k OWNER/BLDR OR PONTRACTOR SIGNATURE DATE Print ame STATE OF FLORIDA COUNTY OF rj _ Ltx ACKNOWLEDGED BEFORE ME THIS a`1 DAY OF p'�' ,20 \� BY WHO IS PERSONALLY KNOWN TO ME OR HAS PROVIDED1'©T' AS IDENTIFICATION. TATE OF FLORIDA,Co of S-Ir .l—yci NpMARIE GIVENS a� � '. My C MMISSION#GG 022023 SIGNATURE OF NO Y ;+: 5r' � �pDecember 16 2020 Bonded?IuuNctaryPubllcUndetwriters 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