HomeMy WebLinkAboutPermit Renewals PLANNING 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: 1:607=0495 ADDRESS: 3385 S U S 'I , FORT PIERCE, FL 34982
I; Donald B Green ,ani 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 We kept pushing back the start.date and we were suposed to start in October, but-the hurricane
set us back and we didnt have enough time to finish the job..
f, x January30,.2017
OWNERJBLDR OR CONTRACTOR SIGNATURE DATE
Donald B Green
Print Name
STATE OF FLORIDA
COUNTY OF t t
ACKNOWLEDGED BEFORE ME THIS '3&'DAY OF �20�
BYi}i
C-II -�1 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
WF ounty of_(,\
JOY HRISTINE COPELAND
SI A. P'NOTARY_ V�P'-7--' SWond�ed'tfirough
COMMISSION#FF946042
EXPIRES:JAN 05,2020
1st State Insurance
FUR OFFICE USE ONLY:.
Number of.Open Inspections:
Totaf Inspections:
(Divide open by total to get%.of open.inspectibns)
Percentage;
Original permit fee: x%open = $ Renewal fee
Example: [1:S divided by 23=:65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014