HomeMy WebLinkAboutProject Information PLAX.6vING AND DEVELOPMENT SFkv CES DEPARTMENT
c. BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ADDRESS: (JE (60(onrl AVe 311
I, D L641 n ,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 1d-uring the renewal period. II�
Justification L moved i n+0 a !" Opq 7r�r<4- c t)ready �l 'a G
Pnce Con.0foc-4e4, Ile'41,640
�encP 1�,�5 bevel' l n �lecrlecQ a�kec c n1e-�;o�,
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O LDR OR CONTRACTOR SIGNATURE DATE
J�5'1 o -
Print Name
STATE OF FLORIDA
COUNTY OF 6\,,L yt Ak `
ACKNOWLEDGED BEFORE G
E THIS DAY OF 0 � 20
` 1�
BY -� �Sk�� `� �r f\ aV"N WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED 1 `— i-- AS IDENTIFICATION.
STATE OF FLORIDA,County S�'_L uc eEli
l DE RIE GNENS
MyCOMMISSIMMISSI ON#GG 022023
SIGNATURE OF NO ARY "� �' EXPIRES:December 16.2020
a.
"-,',;� •o,.• ondod ThN Notary Public Underwriters
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FOR OFFICE USE ONLY: i �
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