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: ZOO't - D G 15 ADDRESS: 'Ok %-1 t4 �A LG1 \V.XtLj r&:�\
11 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
D-e�suze- y I v I Z1
OWNERIBLDR OR CONTRACTOR SIGNATURE DATE
DENNIS ZACEK
Print Name
STATE OF FLORIDA
COUNTY OF ST LUCIE
ACKNOWLEDGED BEFORE ME THIS
BY DENNIS ZACEK
HAS PROVIDED
STATE O FLORIDA, County of ST LUCI E
9IGNATME OF NOTARY
FOR OFFICE USE ONLY:
DAY OF _ Ap( C 1 12021
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.
:g!�041 MIRANDAGILLIS
My COMMISSION # HH 045659
EXPIRES: September 23, 2024
SEAL �`;:F�°`' Banded Thee NotaryPublic UfldeiWliters
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7:2112014