HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982 I� RECEIVED
(772)462-1553 Fox(772)462-15T8
MAY 14 2018
PERMIT RENEWAL REQ TTucie County, Permlttln
PERMIT NUMBER:, tV��1- ADDRESS:
I Dennis Zacek ,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 �,Y� Q.` 2 � N e Yl �-� c\ec
OWNER/EILDR OR CONT 'OR SIGNATURE DATE
Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY OF ST—
ACKNOWLEDGED BEFORE ME THIS DAY OF `� � 20_�
By, Dennis Zacek WHO IS PERSONALLY KNOWN'r0 ME X ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLO ID only of ST Lucie
COLEEN SULLIVAN
G RE NO Y SEAL ;y MY COMMISSION 8 GG071535
EXPIRES Felxuery 06,2021
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get 90 of open inspections)
Percentage:
Original permit fee: x°a open = $ Renewal fee
Example: [15 divided by 23=.65(%)] S175(permit fee)x.65=$113.75(renewal fee)
Revised 712 10)14