HomeMy WebLinkAboutPermit renewalCOIL NTY
F L U R I D A
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 NUMBER: SLC-1910-0575
PERMIT RENEWAL REQUEST
ADDRESS: 3000 NW Radcliffe Way
I, Vicente Delgado , 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 Job was not finished
QR CONTRACTOR SIGNATURE
Vicente Delgado
Print Name
STATE OF FLORMA
COUNTY OF Mlaml daft
ACKNOWLEDGED BEFORE ME THIS 4 DAY OF December
12/04/2020
DATE
2020
BY Vicente Delgado NF 0 IS PERSONALLY KNOWN TO '�' , OR
HAS PROVIDED
STATE vF,�LORIDA, co, my of M IAM I DAD E
SIGNATURE OF
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 = $ Roniwal fee
AS IDENTIFICATION.
SEAL
Example: [15 divided by 23=.65(%)l $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
L
MARIA VIRGINIA SUAREZ
NotaryPublicState of Florida
Commission NGG 1�1508
Q�r?;.� My Comm. Expires Jul 1�, 1012 }�
Bonded through National Not Assn,