HomeMy WebLinkAboutPermit Renewal RequestPLANNING 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 1y0� —J ADDRESS:�—
I, Qam 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
OWNEIZ/BLDR GNATURE
Print Name
STATE OF FLORIDA
COUNTY OF rY k fI W
/o/a f is'
DATE
ACKNOWLEDGED BE0FORE ME THIS 711 DAY OF DG 70 h e Y , 220L-!E—
o� BY %)NlCL 41tt- f WHO IS PERSONALLY KNOWN TO ME X , OR
HAS PROVIDED
STATE OF FLO UDA, Coun of Z3RVW4-R'
�r
ENILIENNE 0'
_ MYCOMMISSIONY�FFZjW3
SIGNATURE OF NOTARY ". '= EXPIREW* 26, 2019 Bonded Thru Notary Pubk Under ibm
FOR OFFICE USE ONLY:
AS IDENTIFICATION.
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
RECEIVED
OCT 14.2015
A2P0045B - Permit Rene rll
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 RECEI V„-D APR 0 %
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: SLC 14090281 ADDRESS: 6189 N US HWY 1 Fort Pierce FL 34946
1, Jose 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 THE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification Contractor changes and re -negotiations caused delays. As a result permit got expired
OR CONTRACTOR SIGNATURE
Jose Delgado
Print Alamo '
3 k 117
DATE
STATE OF FLORIDAA
• "COUNTY OF kxy
a. ACKNOWLEDGED BE
FORE
�JME� THIS DAY OF /�( CG1^ 20 -7
BY .J�6.Cti �1L(�E:(J WHO IS PERSONALLY KNOWN TO ME a`, OR
HAS PROVIDED U /,4 AS IDENTIFICATION.
STATE OF F O ounty of &-v 4C�11,
M tp��Y jK027530]
of Florida
SIGNA OF O ARY SEAL �o� 27530olo'`
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 = $ 5 �O Renewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014