HomeMy WebLinkAboutRENEWALPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINL4 AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2105-0139 ADDRESS: 7775 Guilloti PI. Port St Lucie, FL 34952
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 Delays in material availability and scheduling conflicts prevented permit from
being completed before the expiration
OR CONTRACTOR SIGNATURE
Roberto Sanchez
?rint Name
STATE OF FLORIDA
COUNTY OF S � Lwt-i �
ACKNOWLEDGED BEFORE ME THIS �_ DAY OF
20 �
BY �Lo �'E'O lJ"L WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
,,�""'"S}i�;, JONATHONTHOMAS
5"� MYCOMMISSIONgHH144714
-;` E r EXPIRES: September 18, 2025
BFi ,,, y BoMed 7hnl Notary PWdic tGidennperl
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 7/2l/2014