HomeMy WebLinkAboutPermit renewalPLANNING 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: 1610-0426 ADDRESS: 5093 Bald Cypress Trl
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 - need to schedule inspection to close
O ER/BLDR OR C RACTOR SIGNATURE
Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS 18
BY Dennis Zacek
HAS PROVIDED
St Lucie
FOR OFFICE USE ONLY:
DAY OF September
9/18/2020
DATE
2020
WHO IS PERSONALLY KNOWN TO ME X , OR
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open $ Renewal fee
AS IDENTIFICATION.
MELISSA CHATEAUNEUF
State of Florida - notary Pub! i
Commission # GG 340178
SEAL My Commission Expires May 30 2023
Example: [ 15 divided by 23=.65(%)] $175(permit fee) x .65—$113.75 (renewal fee)
Revised 712112014