HomeMy WebLinkAboutrenewal request PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
" BUILDING AND CODE REGULATIONS DIVISION
TY 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1909-0389 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 stay behind
OWNER/BLDR OR CONT TOR SIGNATURE DATE
Armando Reyes Toledo
Print Name
STATE OF FLORIDA��. �✓
COUNTY OF n
ACKNOWLEDGED BEFORE ME THIS DAY OF b& 20 U
BY Qa"W Q/n fA-0 n) ej-o` WHO IS PERSONA YKNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of ')
OJA
SIGNATU OF NOTARU SEAL
--------------------------------------------------------------------------- - �---------AUBR&YS_kIUMPHREY -------------------------
SAP.. ,.
FOR OFFICE USE ONLY: Y p MY COMMiSS10t�#��G30U -�I;
EXPIRES:March 6,2023 r
9� 0�' N Notary Public Undetwriter� _�
Number of Open Inspections: ,FOFI ,; Bonded
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