HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
MUGS.Y BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
-' - - -- - - FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST N`W/ 0 5 2018
S�Ycie County, Permitting
PERMITNUMBER: 1D�IJ � ADDRESS:
I, i.JCI1�IS ZGt('QK , 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
1�
MrNER/BLRV OR CONTRACTOR SIGNATURE DATE
finis ZaceK
Print Name
STATE OF FLORID
COUNTY OF u,�f ��
ACKNOWLEDGED BEFORE ME THIS_QLAAY OF �� � 20 —
BY LW fib Z�C WHO IS PERSONALLY KNOWN TOME 1/ OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORID o f �. UcAe
ip¢'ro'
;'il H —
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COMCOLL
COLEely Sl�LLI�JA,YYGNATUREOF ARY g A��'o. • ,� MISSIONGG077535° II@ES February 09 202 i
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 = $J Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014