HomeMy WebLinkAboutPermit renewalS-T�Uu,
COUNTY
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F L O R
I D R
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 2002-0556
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 13958 Dalia 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 Got in contact with customer to schedule inspection
Z>'e� U�e'G4 —
OWNER/13LDR OR CONTRACTOR SIGNATURE
Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS 22nd DAY OF September
BY Dennis Zacek
HAS PROVIDED
9/22/2020
DATE
2020
_ WHO IS PERSONALLY KNOWN TO ME X , OR
AS IDENTIFICATION.
ST T FLORIDA, County of St Lucie
MEL ISSA CHASEAUNEUF
State of Florida - Notary Public
SIGNATURE OF NOTARY SEAL Commission # GG 340178
My Commission Expires May 30, 2023
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 1.-7014