HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 2109-0642
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 -Fax (772) 462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 7706 Salerno Rd.
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
OWNER/BLDR OR CONTRACTOR SIGNATURE
Roberto Sanchez
rint Name
11 22
AT
STATE OF FLORIDA
COUNTY OF ,(y� ✓/
ACKNOWLEDGED BEFORE ME THIS � � DAY OF 1 r lQ f , 20 L t—
BY IL��O ` kWUf= WHO IS PERSONALLY KNOWN TOME � OR
HAS PROVIDED
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
AS IDENTIFICATION.
�•"""1�,,, JONATHON THOMAS
MY COMMISSION R IiH 14AT14
EXPIRES: September t8, 2U'16 �i
3`I' 0onded Thm Notary Public Urdxrwril:r
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014