HomeMy WebLinkAboutbuilding permit (2)PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
COUNTY
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2002-0322 ADDRESS: 768 Cypress St
Dennis Zacek
I, D, 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 - made contact with owner to schedule inspection
OWNERIBLDR OR CONTRACTOR SIGNATURE
Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY OF st lucre
ACKNOWLEDGED BEFORE ME THIS 17
BY dennis zacek
HAS PROVIDED
STA "E OF. F OR „ County of st lucle
SIGITATUR - NOTARY
11/17/2020
DATE
DAY OF novernber 2020
WHO IS PERSONALLY KNOWN TO ME X , OR
-------------
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
AS IDENTIFICATION.
MIRANDAGILUS
MY COMMi$810N A HH 045659
s A= EXPIRES:8epteMber 23, 2024
SEAL �kdrn8o4W1WuNftyPubkW*fflr%n
Example: [15 divided by 23=.65(%)] S 175(permit fee) x .65=$113.75 (renewal fee)
Revised 112112014