HomeMy WebLinkAboutPermit RenewalPLANNING 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 1710-0444 ADDRESS: 10680 S Ocean Dr Project
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 would like to request an extension for the above referenced
permit due to a detay in receiving back ordered equipment o complete the proposed work
5/13/20
OWNER/IlLft OR CONTRACTOR SIGNATURE DATE
Stanley Maclin
Print Name
STATE OF FLORIDA
COUNTY OF Palm Beach
ACKNOWLEDGED BEFORE ME THIS p- DAY OF Q 41 , 20 2 t7
BY WHO IS PERSONALLY KNOWN TO ME. OR
HAS PROVIDED
STATE OF FLORIDA, County of K4L ( `yl
SIGNATURE OF 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
:9
YANET RODRIGUEZ
Notary Public - State of Florida
Commission
ea=
SEAL 'AoF
# GG 325980
�o�:
My Comm. Expires Apr 21, 2023
Bonded tht�ugh National Notary Assn.
Wo
Example: [15 divided by 23=.65(%)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 7/21/2014