HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
,COUNTY
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 kFCFl�FO
(772)462-1553 Fax(772)462-1578 �{/�`
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PERMIT RENEWAL REQUEST s °�9OPp 6
PERMIT NUMBER: 1 �V �i) ADDRESS: `� Q� �
I, Dennis Zat('e`C. , 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
OWNER/BL R CONTRACTOR SIGNATURE ' DA E�
I '11n15 ZGtCeK
Print Name
STATE OF FLORID
COUNTY OF�. V -e nd
ACKNOWLEDGED BEFORE ME THIS '�AY OF NON&{ oy- ,20_t&
BY WHO IS PERSONALLY KNOWN TOME 1✓ ,OR
HAS PROVIDED AS IDENTIFICATION.
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FLORID , o f et. Uja
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E&OF ARY
COLEEN SUi.li=w�,:
s ?� ' MY COMMISSION r. �GJ?
SXP►RES February 2i
---------------
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(%)] $175(permit fee)x .65=$113.75(renewal fee)
Revised 7/21/2014