HomeMy WebLinkAboutPERMIT RENEWAL_DempseyBUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT NUMBER: 1908-0317 ADDRESS: 5211 Palmetto Dr
I, Roberto Sanchez , 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 The inspections were not completed and we need this permit active so a final inspection can be scheduled and completed.
OWNERBLDR OR CONTRACTOR SJ&ATURE
Roberto Sanchez
Print Name
STATE OF FLORIDA
�9
COUNTY
DATE
ACKNOWLEDGED BEFORE ME THIS 6'°-- DAY OF , 20
BY Roberto Sanchez
HAS PROVIDED
WHO IS PERSONALLY KNOWN TO ME.X , OR
AS IDENTIFICATION.
STATE OF FLORIDA, County of
SIGNATURE OF NOTARY SEAL
---------------------------------------------------------------------------------------------------------------------------------------------------------
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
&til'on Hallich
ARY PUBLIC
9
; i >)JE OF FLORIDA
GG951577
) 1/27/2024
ACKNOWLEDGED BEFORE ME THIS 6'°-- DAY OF , 20
BY Roberto Sanchez
HAS PROVIDED
WHO IS PERSONALLY KNOWN TO ME.X , OR
AS IDENTIFICATION.
STATE OF FLORIDA, County of
SIGNATURE OF NOTARY SEAL
---------------------------------------------------------------------------------------------------------------------------------------------------------
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