HomeMy WebLinkAboutrenewalPLANNING 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: 2106-0460 ADDRESS: 2703 N Hwy Al A Apt C
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 prevented job from completing prior to permit
S1CiNA'1'URt:
Roberto Sanchez
?rint Name
�, b Z\
DATE
STATE OF FLOIZ�A' - T �,
COUNTY OF lw�`� `�
ACKNOWf LEeLD_1GED BEFORE ME THIS _DAY OF �Y "Q'�— , 20�
BY �0Y3Ya�p � WHO IS PERSONALLY KNOWN TO ME �, OR
HAS PROVIDED
AS IDENTIFICATION.
+°� � MY COMMISSION A HH 1�025
�'�� EXPIRES: September lB,
"•�� BondedThNNotary Public Underndters
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: [IS divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/2l/2014
11o�3Ss�i