HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
® 1 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2003-0503 ADDRESS : 2403 Melon Ct, Fort Pierce
I Roberto Sanchez am requesting that the above permit be reneNved. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, 1
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 In order to schedule final inspection .
AW
OWNER/BLDR OR CONTRACTOR SIGNATURE OATE
Roberto Sanchez
Print Name
STATE OF FLORIDA
COUNTY OF /2 /, ' / !
ACKNOWLEDGED BEFORE
//ME THIS 777 DAY OF 109wele/H- . 20 Zw
BY oolO, � I WHO IS PERSONALLY KNOWN TOME , OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA, County of -- 'allich
ao1PlvMpoo NOTARY PUBLIC
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SIG ATURE OF NOTARY STATE OF F�� DA
Comm# GG951577
Ys/NCE 19�0 Expires 112712024
..........__________e.....___.____.......__.___......__.___......__,__......._______...._____........_.__......
________�_
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(pennit fee) x .65=$ 113 .75 (renewal fee)
Revised 7/21/2014
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