HomeMy WebLinkAboutPermit RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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COUNTY`
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F L Q R
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT NUMBER: Z1 ! 03 Z—L
PERMIT RENEWAL REQUEST
ADDRESS. l 1 H 4I !�Jk O nLAb000 K C
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 r►� ,kC(-
OWNERBLDR OR CONTRACTOR SIGNATURE
DENNIS ZACEK
Print Name
STATE OF FLORIDA
COUNTY OF sT LUC15
11*11zI Izt
DATE
ACKNOWLEDGED BEFORE ME THIS l DAY OF t .12021
BY DENNIS ZACEK
HAS PROVIDED
STATE OF FLORID, , County of ST LUCIE
MAZMZ;j- -
SIGNATL E OF NOTAR
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 IDENTIFICATION,
MIRANDAGILLIS
MY COMMISSION 4 HH 045659
SEAL `+; pP EXPIRES: September 23, 2024
Bonded Thru Notary Public Underwdters
Example: [15 divided by 23=.65(%)] $ l75(permit fee) x .65=$113.75 (renewal fee)
Revised 7-21f2014