HomeMy WebLinkAboutRenewal request SignedPLANNING 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 2103-0778 ADDRESS: 3104 NW RADCLIFEE WAY
I, GEORGE G 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 GET INSPECTION AND CLOSE OUT PERMIT
OWNER/BLDR OR CONTRACTOR SIGNATURE
GEORGE G SANCHEZ
Print Name
STATE OF FLORIDA
COUNTY OF STLUCIE
ACKNOWLEDGED BEFORE METERS 21
BY GEORGE G SANCHEZ
HAS PROVIDED
STATE OF FLORIDA, County of ST LUCIE
d'L' /- R�
GNA F OTARY
FOR OFFICE USE ONLY:
12/21 /2021
DAY OF DECEMBER
DATE
2021
WHO IS PERSONALLY KNOWN TO ME mm� OR
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
AS IDENTIFICATION.
4pa� ftj�' Notary Public State or Ploride
Ashley Simlamany
c My Commission GG W316
A'os* Expires 02i1612024
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65 $113.75 (renewal fee)
Revised T21/2014