HomeMy WebLinkAboutPermit renewal Apr.25.2018 09:57 AM Kuebler Mechanical 7728786344 PAGE. 1/ 2
PLA,NNING.AND DEVELOPMENT SERVICES DEPARTMENT
-Tri 1_1w ��.~_ ,�,;^, BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 349112
(712)462•1553 Fax(772)462-1578
RECEIVED
PERM.[T RENEWAL REQUEST
00'5 701A
Permitting Departmen^
St. Lucie Cqunr,
P}vR1vIIT NUMBER: 1 Uq - � `I Q ADDRESS; 2'zo5 L'r�Sn ° < AR !�,1lix I
Y. A lip.t-° h u�DU -,am re juesting that the above permit be renewed, I
understand that'l must schedule and pass all required inspections for the permit to be finaled. Further,I
understand that this is a ONE TX EENEW ,and the pernnit Shall expire should I not receive a
Passing inspeotion during any six month period during the renewal period.
Justification w 1 krao,� v,;�i�,�1 a p d, 'C V rid, a n Lail 4u
WNPR/BLbR Q$CONTRACTOR SIGNATURE IATB
Print Name
STATE OF FLOR A ,
COUNTY OF
ACKNO EDGED BEFORE ME THIS...`Z. ._-DAY ON
BY WHO IS PERSONALLY KNOWN TO,1 u _,OR
HAS PROVIDED -- _-- AS IDENTIFICATION.
STATE./( FLO DA,County of
1
_ . KENT u est,H Rands
ape. r,1y Commipwn p0 t645p1
SIN B OF NOTARY SEAL +� EM41411/30/7021
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total InsporWom:
(Divide open by total to get%of open inspcctions)
Percentago:
Original permit fee: x%open m $ Rionowal fee
Example: 115 divided by 23=.65(%)J $175(ponuit fee)x.65=$113.75(renewal fee)
Revised 7121(2014