HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
7BUILDING AND CODE REGULATIONS DIVI ON
2300 VIRGINIA AVE RECEIVED
- FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
Nov o5 zoos
PERMIT RENEWAL REQUEST L
Ducie County, permitking
PERMIT NUMBER: I 9- c4— bgoa ADDRESS: I `1 i �-CSbwj
Zac e K , 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
Dennib
OWNER/BLIV OR CONTRACTOR SIGNATURE DATE
Dans ZaceK
Print Name
STATE OF FLORID
COUNTY OF 15-�-. (_t e �d
ACKNOWLEDGED BEFORE ME THIS �AY OF ,20' )
BY ,I vii<ta&.� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
%NATURE
FLORID of f . �(�� ;i�`�av°-� 's 'COLEEN SULLIVAN
Pit) - MY COMMISSION#GG071535
�:°' EXPIRES February 09,2021
OF ARY SEAL
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 = $ Renewal fee
Example: [15 divided by 23=.65(%)] S 175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014