HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER 1 i V(00 ADDRESS: C)C�U
IDennis 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 Permit Expired
�tivs. s� _1 z, v
OWNER/BLDR O NTRACTOR SIGNATURE DATE
_ Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY OF St Lum County
ACKNOWLEDGED BEFORE ME THIS 1\ DAY OF A{ .20 zo
$Y `))cA eQunes WHO IS PERSONALLY KNOWN TO ME-_ ,OR
HAS PROVIDED Drivers License AS IDENTIFICATION,
ST E OF FLORI ,County or ::A C.�1ut nun-t m MELISSA CHATEAUNEUF
State of Florida-Notary Public
1commission#GG 340178
SIG ATURE OF NOTARY SEAL My Commission Expires May 30,2023
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Revised 7:71/2014