HomeMy WebLinkAboutPermit renewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
r1 BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34"2
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2001-0218 ADDRESS. 1375 Nettles Blvd
1, 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 Customer is out of country due to Covid-19
OWNER/BLDR OR CWRACTOR SIGNATURE
Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY OF atL.
ACKNOWLEDGED BEFORE ME THIS 5th
BY Dennis Zacek
HAS PROVIDED
STATE OFF OR A County of y $t LucieSl ATURE OF NOTARY
FOR OFFICE USE ONLY;
11/5/2020
DATE
DAY OF November . 2020
WHO IS PERSONALLY KNOWN TO ME X , OR
Number of Open Inspections:
Total Inspections: _
(Divide open by total to get °o of open inspections)
Percentage: __....
Original permit fee: _ x % open S Renewal fee
AS IDENTIFICATION
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3 '3F : my com
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SEAL a
Example. [ l 5 divided by 23=.65(%)] $175(permit fee) x .65 =S 113.75 (renewal fee)
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