HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST NOV 0 5 W8
T. Lucie County, Permitting
PERMIT NUMBER: U� ��`✓V ADDRESS: Saf* l
I,jDenhis ZoceK , 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
DeitfiZo r&
MWER/131,99 OR CONTRACTOR SIGNATURE ATE
finis ZaceK
Print Name
STATE OF FLORIDA
,
COUNTY OF L J'�. Ns1Jf� a
ACKNOWLEDGED BEFORE ME THIS ( 'JV111 AY OF j_aM•Y� ,20 I o,
BY an06 ta&=k WHO IS PERSONALLY KNOWN TO ME V ,OR
HAS PROVIDED AS IDENTIFICATION.
%GNA
FLORID of f , �1JC4�
`� SULLIVAN
My COMMISSION#GG071535
E OF ARY SE "•roc'd;Q'
EXPIRES S February 09,2021
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 = $—72�Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014
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