HomeMy WebLinkAboutPermit renewal formPLANNING 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: 1901-0541 ADDRESS: 4416 N HWY Al A
I, ARMANDO REYES TOLEDO . 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 Sub contractor schedule stay behind
OWNEWBLDR OR CON;rRACTOR SIGNATURE
Armando Reyes Toledo
Print Name
ATE
STATE OF FLORID
COUNTY OF ' 1
ACKNOWLEDGED BEFORE ME THIS CVf1_1 DAY OF �V �u 20(:::'1
IS MOST --
HAS PROVIDED
AS IDENTIFICATION.
STATE'9F FLO A, un of
............
KARINA J. ARROYO
SIN OF NOT Y NotargPdtWc • State of Florida
Commission # HH 019674
MyC°mm.ExpiresJu19,2024
through National Notary Assn.
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(1/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014