HomeMy WebLinkAboutpermit renewalPLANNING 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: _ � — OZ M ADDRESS: k 09 IV 'S�'(V\
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 Cu hAuCA (P-1-AV CLJS -{, -
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OWNER/BLDR OR CONTRACTOR SIGNATURE
DENNIS ZACEK
Print Name
STATE OF FLORIDA
COUNTY OF ST LUCIE
�l{5(z-I
DATE
A(KNOWLEDGED BEFORE ME THIS (5 DAY OF f�QC < \ 12021
BY DENNIS ZACEK
HAS PROVIDED
STATE OF LORI ,Countyof ST LUCIE
. A A
SIG A F NOTARY
FOR OFFICE USE ONLY:
WHO IS PERSONALLY KNOWN TO ME X , OR
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
AS IDE (CATION.
:;?`""'''``•, MIRANDAGILLIS
MY COMMISSION # NN 045659
EXPIRES: September23.2024
Bonded Thru Notary Public Un -;;tars
SEAL
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7,21/2014