HomeMy WebLinkAboutProduct Approval PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-157r RECEIVED
i
= MAY 14 2018
PERMIT RENEWAL I2EQU ST
5T. Lucie County, Permitting
PERMITNUMBER: ty1 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 Lai ')� f\C5 k C'Ql'a(`�t"1
OWNERIBLDR OR CONTI 'OR SIGNATURE DATE
Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY 01' --
ACKNOWLEDGED BEFORE ME THIS DAY OF J 20—a—
BY Dennis Zacek WHO IS PERSONALLY OWN TO ME X .OR
HAS PROVIDED _ AS IDENTIFICATION.
s'r L A, T Lucie
COLEEN SULLIVAN
MY COMMISSION#GG071535
S A 0 AR ' SEAL EXPIRES February 09,2021
FOR OFFICE USE ONLY:
Number of Open Inspections: of d
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = S Renewal fee
Example. [15 divided by 23=.65(%)] $175(permit fee)x.65=$]13.75(renewal fee)
Revised 702 1 1014