HomeMy WebLinkAboutMisc Letters 772-770-0064 ARS 10:22:48 a.m. 10-14-2016 1/2
`... PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
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2300 VIRGINIA AVE
- FORT PIERCE,FL 34982 ((�; �' �1,
(772)462-1553 Fax(772)462-1578 l' �EC EE!,; If
PERMIT RENEWAL REQUEST OCT 14, 2016
PERFAITTING
St.. Lucie County, FL
PERMIT NUMBER: ��� ,�, tJ �\ ADDRESS:
I Dennis Zacek ,am requesting that the above permit be renewed. I
understand that 1 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 renew period.
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OWNER/BLDR OR CONTRe I'OR SIGNATURE DATE
Dennis Zacek
Print Name
STATE OF FLORIDA
COUNTY OF ST hide
ACKNOWLEDGED BEFORE ME TH15DAY OF t.2-e Ot ,20
BY Dennis Zacek WHO I5 PERSONALLY KNOWN TO ME X OR
HAS PROVIDED AS IDENTIFICATION.
LATURE
E OF FLO A,Conty ST Lucie
OF TiRY =A2
Y
1�� 220930EX201911071397-Q•5Jcrr
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7121/2014