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: bill 01`9 ADDRESS: 45 t 0-_6_ &��,cU S Ave
I, Dennis 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
OWNER/BLDR gp
&6NTRACTOR SIGNATURE DATE
Dennis Zacek
Print Name y-
STATE OF FLORIDA
COUNTY OF St4-je.cointy //
ACKNOWLEDGED BEFORE
�M]E�THIS�i,�,�( DAY OF May ,20 9v
BY gF�tt� Q�C A eQk)nt"LC WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED Drivers License � AS IDENTIFICATION.
ST E OF FLORID ,Comity of�t {.�{ C(t MELISSA CHATEAUIVEUF
State of Florida-Notary Public
Commission#GG 340178
SIG K ATURE OF61 O TARY/�� SEAL My Commission Expires May 30,2023
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Revised 7P'2112014