HomeMy WebLinkAboutPermit renewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER: 2001-0235
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34"2
(772) 462-1553 Fax (772) 462-IPS
PERMIT RENEWAL REQUEST
ADDRESS: 3060 Five Iron Dr
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 New home owner contacted to get dosed out
OWNERBL Q6 CO"A&tOR SIGNATURE
Dennis Zacek
Print Name -- —
STATE OF FLORIDA
COUNTY OF 81 Luck
12/22/2020
DATE
ACKNOWLEDGED BEFORE ME THIS 22 DAY OF December , 202a
BY Dennis Zacek WHO IS PERSONALLY KNOWN TO ME X , OR
HAS PROVIDED -
AS IDENTIFICATION
STATE OF FLORIDA, Coen of $t Lucie ;;r'+;+;i;- INIRIWDAGILLIS
?!". ` EXPIRES Septer 23, 2024
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SIGNATU OF NOTARY d' r':�°•' 11w
SEAL Bonded Irotae)r
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 = S Renewal fee
Example: [15 divided by 23-.65(%)] $175(permit fee) x-65-S113.75 (renewal fee)
Rewsed 7121r2014