HomeMy WebLinkAboutpermit renewal (2)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 NUMBER: 1707-0171
PERMIT RENEWAL REQUEST
ADDRESS: 2807 LANGSTON DR
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 CONTACTED CUSTOMER TO GET INSPECTION SCHEDULED
OWNt RIBLDR OR CONTRACTOR SIGNATURE
DENNIS ZACEK
Print Name
STATE OF FLORIDA
COUNTY OF sT LuCIE
ACKNOWLEDGED BEFORE ME THIS 28
By DENNIS ZACEK
HAS PROVIDED
9/28/2020
DATE
DAY OF SEPTEMBER 2020
WHO IS PERSONALLY KNOWN TO ME X , OR
AS IDENTIFICATION.
ST OF FLORIDA, County of IV L U C I E [State
LISSA CHATEAUIVEUF
r of Florida - Notary Public
ommission # GG 340i78
SI A F OTA SFAL mmission Expires May 30, 2023
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections.
(Divide open by total to get'/a of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
Example: [l5 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7 ? 1+7014