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HomeMy WebLinkAboutPermit Renewals 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 ✓��� P dd" PERMIT NUMBER: �'� ©� ADDRESS: / � -' /V Lir0rii 9-_/ i ZP�((L C--:2 0-f) am requesting that the above permit be renewed. I understand that I must sch@dule 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,; '(�LtY UI k q 0' Coa cvrc. er f a;ho q U+��Cl< a�0,0 Ps; Wi Ga F btr— MeS k SG'0 Q+ CDf Nf_{r ,, , Uo S-I-ruA irze5 , �O ERBLik R NTRA TOR SIGNATURE DATE r (� 0 �s .x C I?rin�Name STATE OF FLORIDA COUNTY OF V �,�- ACKNOWLEDGED BEFORE ME THIS_ID DAY OF� V 20� BY t c,( 'U,6 Ca f"1U WHO IS PERSONALLY KNOWN TOME ,OR HAS PROVIDED C(/ O ft—®A Vbfk AS IDENTIFICATION. /' I REQUIEL SOTO STATE OF FLORIDA ounty of I444vffl— r a Notary public,State of Florida Commisslorg FF 217260 My comm.expires April 5,2019 SIGNATURE OF NOTARY SEAL -------------------------------------------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY: 4Z 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