HomeMy WebLinkAboutexecutedPLANNING 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: SLC 1901-0546 ADDRESS: 6375 S US HIGHWAY 1
I, Stanley Maclin , 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 MasTec Network Solutions would like to request an extension for the above referenced
permit due to a delay in receiving back ordered equipment to complete the proposed work
OWNE D OR CONTRACTOR SIGNATURE
Stanley Maclin
Print Name
STATE OF FLORIDA
COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS 13 DAY OF May
BY Stanley Maclin
HAS PROVIDED
STATE OF FL RI County of ST. Lucie
SIGNATURE F TARY
5/13/20
DATE
2020
WHO IS PERSONALLY KNOWN TO ME X , OR
AS IDENTIFICATION.
SEAL
My Comm. Expires Apr 21, 2023
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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
AY PGe'••
YANET RODRIGUEZ
Notary Public -State of Florida
,�,�!:
Commission � GG 325980
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Bonded through National Notary Assn.