HomeMy WebLinkAboutPermit RenewalsPLANNING 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: 1� �—�O • Oam ADDRESS: ,_o—_:W Aa6a2j _ e
i, ��S t�• Jd�t?"S' , 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 / —�1
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OR CONTRA OR SIGNATURE DATE
Name
STATE OF FLORID �� 1 , „ ,.. ;
COUNTY OF c] (�
ACKNOWLEDGED BEFORE ME THIS'D DAY OF 0(2—r, 20—IG
BY t�St! , WH �ALLYTO ME , OR
HAS PROVIDED
TE OF FLORID4. County of
SIGNATURE Or NOTARY
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
AS IDENTIFICATION.
Example: [15 divided by 23=.65(%)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 7/21/2014
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ANGELA M HUFF
Notary Publlo . State of Florida
SEAL'' ' =
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Commission # FF 234730
vly Comm. Expires May 27, 2019
.i„�d.• d through National Notary Assn.
Example: [15 divided by 23=.65(%)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 7/21/2014