HomeMy WebLinkAboutPermit RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 1903-0485
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 336 SE Tranquila Port St Lucie
I, Donald B Green , 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 Need to reopen expired permit and have final inspection completed.
-- 1'/2020
ER/BLDR OR CONTRACTOR SIGNATURE DATE
Donald B Green
Print Name
STATE OF FLORID
COUNTY OF
ACKNOWLEDGED BEFORE ME THISD Y OF .2
r— 0
By �i0 IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED
AS IDENTIFICATION.
o - L''w!
pZf W0jLf1 s Kha jP so-
OF OTARY Notary Pubkc Stele of Pkwide SE Z511CB �J ueytsiu�woa �ip1 A I
pueladoo auOP43 Aor
Joy Christine Copeland
MY Commkobn GG 937752 spltci io eQetS �14nd IoN
V ExpiresGiffifir u M
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: [15 divided by 23=.65(%)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 7/21/2014
COUNTY
FL Q
R I D A'
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 1903-0485
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 336 SE Tranquila Port St Lucie
I, Donald B Green , 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 Need to reopen expired permit and have final inspection completed.
-- 1'/2020
ER/BLDR OR CONTRACTOR SIGNATURE DATE
Donald B Green
Print Name
STATE OF FLORID
COUNTY OF
ACKNOWLEDGED BEFORE ME THISD Y OF .2
r— 0
By �i0 IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED
AS IDENTIFICATION.
o - L''w!
pZf W0jLf1 s Kha jP so-
OF OTARY Notary Pubkc Stele of Pkwide SE Z511CB �J ueytsiu�woa �ip1 A I
pueladoo auOP43 Aor
Joy Christine Copeland
MY Commkobn GG 937752 spltci io eQetS �14nd IoN
V ExpiresGiffifir u M
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: [15 divided by 23=.65(%)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 7/21/2014