HomeMy WebLinkAbout Request to renew permit letterCOUNTY
F
L A
R I D A
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: Ud'A — 03^l ADDRESS: (00 1 Z
cGc;1/1 L Gl t TC— r
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 . Uy� UuU
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OWNERBLDR OR CCaTRACTOR SIGNATURE
DENNIS ZACEK
Print Name
STATE OF FLORIDA
COUNTY OF sr LUCIE
1olzi IZ1
DATE
ACKNOWLEDGED BEFORE ME THIS DAY OF QCAO 1 , 202
BY DENNIS ZACEK WHO IS PERSONALLY KNOWN TO ME X , OR
HAS PROVIDED
STATE OF FLORIDA, County of ST LUCIE
SIGNATURE'OF NOTARY
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get 1,o of open inspections)
Percentage:
Original permit fee: x % open = 5 Renewal fee
AS IDENTIFICATION
MIRANDAGILLIS
;�• ,; MY COMM=ION II HH 045W
SEAL EXPIRES: September 23, 2024
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Example: [15 divided by 23=.65(" ' )] $175(permit fee) x .65=$113.75 (renewal fee)
Revised? 21r'2G14