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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 .. F 0 . oe4� -- 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 "..°� ..•'� 6mododTWNotary PubleUrr wmftm Example: [15 divided by 23=.65(" ' )] $175(permit fee) x .65=$113.75 (renewal fee) Revised? 21r'2G14