HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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I BUILDING AND CODE REGULATIONS DIVISION
• R I D A 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2002-0733 ADDRESS: 10701 S Ocean Dr Unit 923
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 Customer just came back to Florida
1/14/2021
OWNER/BLDR OR NTRACTOR SIGNATURE DATE
Dennis Zacek
Print Name
SLATE OF FLORIDA
COUNTY OF ST L UOF
ACKNOWLEDGED BEFORE ME THIS 14 DAY OF JANUARY .2021
BY DENNIS ZACEK _ WHO IS PERSONALLY KNOWN TO ME X ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OFF RID County of ST LUCIE
' ;r:►ii'•,• MIRANDAGILLIS
*, 41 W COAIMSSION#HH 045659
SIGNATURE OF NOTARY SEAL ;�, gpUMmftn
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 W2 W014