HomeMy WebLinkAboutPermit Renewals PT..ANNING AND DEVELOPMENT SERVICES DEPARTMENT
i' BUILDING AND CODE REGULATIONS DIVISION
COUNTY
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
RECEIVED
PERNUT RENEWAL REQUES
MAY 14 2018
ST. L-06A Gaun[y, f'ei'ftilCCfny
PERMIT NUMBER: ADDRESS:
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 �(�(`� � yo c1pah
OWNER/BLDR OR CONTR •OR SIGNATURE DATE
Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY OF ST L.-
ACKNOWLEDGED BEFORE ME THIS DAY OF 1 A CW 20
BY Dennis Zacek WHO IS PERSONALLY KNOWN TO ME X �OR
HAS PROVIDED AS IDENTIFICATION.
S T OFF RID ,Co of ST Lucie
v COLEEN SOLI 'r71
MY COMMISSION#
RE F T SEAL EXPIRES February A
FOR OFFICE USE ONLY: COLEEN SULLIVAN
�•�' ")*
Number of Open Inspections: Iy MY COMMISSION#GG071535
Total Inspections: �. EXPIRES Feb,,,y 09,2021
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = S Renewal fee
Example: [15 divided by 23=.65(1%)I $175(pertnit fee)x.65=$113.75(renewal fee)
Revised 7/1-1 M- 14