HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee DI` Recei t# Permit #
L4 7
Planning p & Development Services /-�JD
Building & Code Regulations Division
2300 Virginia Ave.
i Fort Pierce, FL 34982
(772)462-1553
8y SPECIALTY PERMIT APPLICATION
St. Lucie County
❑ Electrical ❑ Plumbing V HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 3 i C7 ? n e ' hawse '""''1 ��' �� `i PAL 1���� 3tiqq&
2. Parcel ID Number:
Office Use
Only
Section
Township
Range
Mp Page
a
Zoning
Land Use
Initials
3. Complete Description of Projector Work: AC)IN ►3 Set; I•
4. Owners Information 5. Contractors Information
Name: MCIV P,w,.4, , �` (1 r I P� �r�n v FL Reg/Cert #: ' r I g 1,9 � z s—
Address: 131c,x zno j County Cert#:
City: �o;,,� r State: iN Business Name: 14�L 0►'li9rrn Y�i qS
3 -
Phone: Flo , � o Fax: 3 fic> 'g
Zip: .��'Z Phone: ,J�¢(�'79i^' �.7 +
6. Value of Construction: S ._'is��-�
OWNER'S AFFIDAVIT: I certify that all of the information contained m this application is correct and that all work will be done in
compliance with all applicable laws regulating construction and zoning.
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF S" L"J 2L
ACKNOWLEDGED BEFORE ME THIS DAY OF _, 20 ' BY
O IS PERSONALLY KNO OR WHO HAS PRODUCED —
AS IDENTIFICATION.
:f0 4'J wJ Y bb Notary PAc Ptate of Florida
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY ' , ?° John Robert Mann
My Commission EE 627605
COMMISSION NUMBER ` � 6�'S i tir a+ Expires 08/16/2016
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
BUILDING PERNIIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
a6®_5�_7
State of Florida Certification Number (ifappticable): /29 nc)% �Z 9 /
have agreed to be the
(Company Name/Individual Name)
6 - � �I c/: I - �_ sub -contractor for e�%G %��j,$�i{✓�iil�
(Type of Trade) (Primary Contractor)
for the project located at J���"'O % At U) k1 A,e �f " C 7;3'"
'(Project Street Address or Property x ID #)
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
Y� � r /J
DATE
Business Name:
Address:
City/State/Zip:
Phone:
C-�` -e f
71%Z =z?Y (-r'O y email:
OFFICE USE ONLY:
PERMIT # ISSUE DATE
i
-rp- wrigntsotr ....j—ps Date:
Entire House By.
QUICK CALCS, INC.
317 ST. LUCIE LN., FT. PIERCE, FL 34946 Phone: 772-466-6799 Fax 772-466-6796 Emall: OUCKCALCS@AOLCOM
Project• •
For: RALPH PATONY
13507 NW WAX MYRTLE TR., PALM CITY, FL
Notes:
Weather: Fort Pierce, FL, US
Winter Design Conditions
Outside db
42
OF
Inside db.
70
OF
Design TD
28
OF
Heating Summary
Structure
11615
Btuh
Ducts
2913
Btuh
Central vent (0 cfm)
0
Btuh
Humidification
0
Btuh
Piping
0
Btuh
Equipment load
14528
Btuh
Infiltration
Method
Construction quality
Fireplaces
Simplified
Average
0
Heating Cooling
Area (W)
682
682
Volume (ft3)
5456
5456
Air changes/hour
0.61
0.32
Equiv. AVF (cfm)
55
29
Heating Equipment Summary
Summer Design Conditions
Outside db
Inside db
Design TD
Daily.range
Relative humidity
Moisture difference
90 OF
75 OF
15 OF
L
50 %
61 grAb
Sensible Cooling Equipment Load Sizing
Structure
13278
Btuh
Ducts
4417
Btuh
Central vent (0 cfm)
0
Btuh
Blower
0
Btuh
Use manufacturer's data
n
Rate/swing multiplier
0.95
Equipment sensible load
16810
Btuh
Latent Cooling Equipment Load Sizing
Structure
1616
Btuh.
Ducts
1178
Btuh
Central vent (0 cfm)
0
Btuh
Equipment latent load
2794
Btuh
Equipment total load
19604
Btuh
Req. total capacity at 0.70 SHR
2.0
ton
Cooling Equipment Summary
Make
Make Goodman Mfg.
Trade
Trade
Model
Cond GSX130241 C"
AHRI ref no. n/a
Coil ARUF24
AHRI ref no.
Efficiency
100 EFF
Efficiency 11.0 EER, 13 SEER
Heating input
0
Btuh
Sensible cooling
16100
Btuh
Heating output
14528
Btuh
Latent cooling
6900
Btuh
Temperature rise
17
OF
Total cooling
23000
Btuh
Actual air flow
767
cfm
Actual air flow
767
cfm
Air flow factor
0.053
cfm/Btuh
Air flow factor
0.043
cfm/Btuh
Static pressure
0
in H2O
Static pressure
0
in H2O
Space thermostat
Load sensible heat ratio
0.86
Calculations approved byACCA to meet all requirements of Manual J 8th Ed.
i htsoftD 2013-May-2010:35:36
wr
.+- g RightSuite® Universal 201212.0.07 RSLU101 Page 1
A'CK C:\Users\Quk k CaleMocuments\WrightsoR WAMPATOW, RALPH.rup Cale = MJ8 Front Door faces:
Entire House
QUICK CALLS, INC.
317 ST. LUCIE W., FT. PIERCE, FL 34946 Phone: 772-466.6799 Fax 772-46&M5 Email: OIACKCALCS@AOLCOM
Date:
ey:
1
Room name
Er fire House
GARAGE
2
3
Bposed Wag
Room height
114.0 ft
8.0 ft d
114.0 ft
8.0 ft heat/Cool
4
5
Room dmnenstans
Room area
6820 ftz
1.0 x 682-0 ft
6820 W
Ty
Construction
LMdiue
Or
HTM
Area (ftZ)
Load
Area
number
(Bluhlftz°F)
(Btllh m
or pemt neer (ft)
(Bfub)
perut eter (ft)
(Btuh)
Heat
Cool
Gross
N/PIS
Heat
Cool
Gross
WP/S
Heat
Cool
6
W
Vlf
�— 0
13A40CS '
13A-4ocs
11Po
0.143
0.143
0.290
ne
se
se
4.00
400
8.12
2.55
2.55
8.41
192
254
145
192
119
145
769
478
M75
489
304
1217
192
264
145
192
119
145
769
478
1175
489
304
1217
11
19A-4ocS
1A-Clan
13A-0aS
1A-C1an
16AaW
0.143
1.270
0.143
1.270
0.032
sw
sw
rw
nw
-
4.00
35.56
4.00
35.55
0.90
2.55
X95
2.55
70.43
2.32
192
30
284
30
682
162
0
234
0
682
649
1057
937
1067
611
412
2128
596
2113
1582
192
30
30
682
102
0
0
682
649
1057
937
1067
611
412
2128
596
2113
1582
W
�---G
C
F
2"
0.989
-
27.69
0.00
682
114
3157
0
602
114
3157
0
6
C) AED ea ursion
1498
1498
ape losslon
9"
10338
9908
103M
12
a) Infiltration
1707
480
17(17
480
b) Roan ventila ion
0
0
0
0
13
Internal gains: Occupants 0 230
2
460
2
460
Appgances/other
2000
2000
Subtotal Vines 6 to 13)
11615
13278
11615
13278
Less external load
0
0
0
0
14
R
Subtotal
0
11615
0
13278
0
11615
0
13278
15
Duct loads
25%
330%
2913
4417
251/6
330/6
2913
4417
Total marl load
Air required (cfm)
14528
767
17695
767
1
145M
767
17695
767
Calculations aoD%v_ed_ bvACCA to meet all requirements of Manual J 8th Ed.
wrigtrttsc ft- - - 2013-May-2010:35:36
ACE` Right-Suke@ Lk- -W 201212.0.07 RSUOM01 Page 1
CAUsers\Quick CaicMDocuments\Wrfghtsol ,,tPATONY, RALPH.rup Cale = MJ8 Front Door faces:
This document was created with Win2PDF available at hftp://www.win2pdf.com.
The unregistered version of Win2PDF is for evaluation or non-commercial use only.
This page will not be added after purchasing Win2PDF.
� � i
FORM 405-10
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
Florida Department of Business and Professional Regulation - Residential Performance Method
rojectName: RALPH PATONY
Builder Name:
treet: 13507 NW WAX MYRTLE TR.
F
Permit Office:
ity, State, Zip: PALM CITY, FL,
Permit Number.wner.
Jurisdiction:
esign Location: FL, Fort Pierce
1. New construction or existing New (From Plans)
9. Wall Types (1026.0 sgfL)
Insulation Area
2. -Single family or multiple family Single-family
a. Concrete Block - Ext Insul, Exterior
R=4.1 1026.00 ftz
b. NIA
R= fF
3. Number of units, if multiple family 1
c. WA
R= fF
4. Number of Bedrooms 0
d. N/A
R= fF
5. is this a worst case? No
10. Ceiling Types (682.0 sgfL)
Insulation Area
a. Under Attic (Vented)
R=30.0 682.00 fF
6. Conditioned floor area above grade (ft2) 682
b. N/A
R= ft2
Conditioned floor area below grade Qf) 0
c. NIA
R= fF
11. Ducts
R ft2
7. 'Mndows(60.0 sgft.) Description Area
a. Sup: Attic, Ret: Attic, AH: Main
6 105
it. U-Factor. Sgl, U=1.07 60.00 fF
SHGC: SHGC=0.50
b. U-Factor. WA ft2
12. Cooling systems
kBhft Efficiency
SHGC:
a. Central Unit
23.0 SEER:13.00
c. U-Factor, NIA fF
SHGC:
13. Heating systems
kBtulhr Efficiency
cf. U-Factor: N/A ft2
a. Electric Strip Heat
17.0 COP:1.00
SHGC:
1%rea Weighted Average Overhang Depth: 2.000 fL
Area Weighted Average SHGC: 0.500
14. Hot water systems
8. Door Types (682.0 sgft.) Insulation Area
a.
a. Slab -On -Grade -Grade Edge insulation R=0.0 682.00 fF
b. Conservation features
EF: 0.000
b. NIA R= fF
c:. WA R= fF
15. Credits
Glass/Floor Area: 0.088 Total Proposed Modified Loads: 14.79
PASS
Total Standard Reference Loads: 18.53
I hereby certify that the plans and specifications covered by
Review of the plans and
OF -TOES'"
this: calculation are in compliance with the Florida Energy
specifications covered by this
_IV
Cale.
calculation indicates compliance
_;',,- f
-
with the Florida Energy Code.
:::;r G•-.' .•'-•„ O
PREPARED BY:
Before construction is completed
Q s r�sr 1 70
a
DATE: i
this building will be inspected for
compliance with Section 553.908�
� O
I hereby certify that this building, as designed, is in compliance
Florida Statutes.
�COp
with the Florida Energy Code.
yvET¢J�
OWNERIAGENT.
BUILDING OFFICIAL:
DATE:
DATE:
5,20/201310.40 AM EnergyGauge® USA - FlaRes2010 Section 405.4.1 Compliant Software Page 1 of 5
PROJECT
Title:
Building Type:
Owner.
# of Units:
Builder Name:
Permit Office:
Jurisdiction:
Family Type:
New/E)Mng:
Comment:
RALPH PATONY
User
1
Single-family
New (From Plans)
Bedrooms: 0
Conditioned Area: 682
Total Stories: 1
Worst Case: No
Rotate Angle: 0
Cross Ventilation: No
Whole House Fan: Yes
Address Type:
Lot #
Biock/SubDMsion:
PlatBook:
Street:
County:
City, State, Zip:
Street Address
13507 NW WAX MYRT
ST. LUCIE COUNTY
PALM CITY,
FL,
CLIMATE
V Design Location
IECC Design Temp
TMY Site Zone 97.5 % 2.5 %
Int Design Temp Heating Design Daily Temp
Winter Summer Degree Days Moisture Range
FL, Fort Pierce FL ST LUCIE CO INTL 2 39 90
70
75 722
62 Low
BLOCKS
Number
Name
Area Volume
1
Biockl
682 6138
SPACES
Number
Name
Area Volume Kitchen Occupants
Bedrooms
lnfli ID Finished Cooled Heated
1
Main
682 6138 Yes 2
1 Yes
Yes Yes
FLOORS
#
Floor Type
Space Perimeter R-Value
Area
Tile Wood Carpet
1 Slab -On -Grade Edge Insulatio Main 89 ft 0
682 fe
0 0 1
ROOF
#
Type
Roof Gable Roof
Materials Area Area Color
Solar
Absor.
SA Emitt
Tested
Emitt Deck Pitch
Tested Insul (deg)
1
Hip
Barrel tile 739 f Z 0 ftz Medium
0.96
No 0.9
No 0 22.6
ATTIC
#
Type
Ventilation Vent Ratio (1 in)
Area
RBS IRCC
r 1
Full attic
Vented 300
682 ttz
N y N
w
CEILING
#
Ceiling Type
Space R-Value Area
Framing Frac
Truss Type
1
Under Attic (Vented)
Main 30 682 ftZ
0.11
Wood
5120/201310.40 AM EnergyGauge® USA - FlaRes2010 Section 405.4.1 Compliant Software Page 2 of 5
WALLS -
1
Adjacent Space Cavily Width Height Sheathing Framing Solar
Below
1
2
3
4
N Exterior Concrete Block - Ext Insul Main
E Exterior Concrete Block - Ext Insul Main
S Exterior Concrete Block - Ext Insul Main
S Exterior Concrete Block - Ext Insul Main
4.09999 24 9 216.0 ftz 0 0 0.75
4.09999 33 9 297.0 fig 0 0 0.75
4.09999 24 9 216.0 ft2 0 0 0.75
4.09999 33 9 297.0 ftF 0 0 0.75
0
0
0
0
DOORS
V
# Omt Door Type Space
Storms U Value Width Height
Ft In Ft In
Area
1 N Insulated Main
2 N Insulated Main
None 0.460000 10 a
None 0.460000 10 8
80 ft=
80 f?
WINDOWS
Orientation shown is the entered, Proposed orientation.
I
Wall
# Omt ID Frame Panes NFRC
Overhang
U-Factor SHGC Area Depth Separation Int Shade
Screening
^_
1 S 3 Metal Single (Turfed) Yes
2 S 4 Metal Single (r-uded) Yes
1.07 0.5 30.0 flz 2 ft 0 in 6 ft 0 in Drapesiblinds
1.07 0.5 30.0 flz 2 ft 0 in 6 ft0 in Drapesibfinds
None
None
INFILTRATION
#
Scope Method SLA
CFM 50 ELA EgLA ACH ACH 50
1 Wholehouse Best Guess 0.0005W
894.448 49.1040 92.3473 0.36500 8.74338
HEATING SYSTEM
'-
# System Type Subtype
Efficiency Capacity Block
Ducts
OnvaliElectric Strip Heat None
COP: 1 17 kBhAw 1
sys41
COOLING SYSTEM
# System Type Subtype
Efficiency Capacity Air Flow SHR Block
Ducts
QnvafiCentral Unit None
SEER: 13 23 kBtu/hr 690 cfm 0.75 1
sys#1
SOLAR HOT WATER SYSTEM
FSEC
Cert # Company Name
Collector Storage
System Model # Collector Model # Area Volume FEF
f12
DUCTS
— Supply — — Retum — Air CFM25 HVAC #
Location R Value Area Location Area Leakage Type Handler CWU25 OUT QN RLF Heat Cool
(Invali Attic 6 105 ftz Attic
15 fF Default Leakage Main (invalid) cf (Default)
1 1
520/201310*40 AM EnergyGauge® USA - FlaRes2010 Section 405.4.1 Compliant Software Page 3 of 5
TEMPERATURES
Programable Thermostat: Y Ceiling Fans:
Ccooi!ng
Heatin
Jan
Jan
H Feb
Feb
MarWApr
Mar
r
]MayJun
Ma
Jun
Jul
Jul
AugSe
Auge
Oct
WOct
HNov
Nov
Dec
Dec
Venting
Jan
FebX
Mar
P�ipr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Thermostat Schedule:
HERS 2006 Reference
Hours
Schedule Type
1
2
3
4
5
6
7
8
9
10
11
12
Goofing (WD)
AM
78
78
78
78
78
78
78
78
80
80
80
80
PM
80
80
78
78
78
78
78
78
78
78
78
78
Cooling (WEH)
AM
78
78
78
78
78
78
78
78
78
78
78
78
PM
78
78
78
78
78
78
78
78
78
78
78
78
Heating (WD)
AM
66
66
66
66
66
68
68
68
68
68
68
68
PM
68
68
68
68
68
68
68
68
68
68
66
66
Heating(WEH)
AM
66
66
66
66
66
68
68
68
68
68
68
68
PM
68
68
68
68
68
68
68
68L
68
68
66
66
r
51201201310:40 AM EnergyGauge® USA - FhaRes2010 Section 405A.1 Compliant Software Page 4 of 5
FORM 405-10
Florida Code Compliance Checklist
Florida Department of Business and Professional Regulations
Residential Whole Building Performance Method
ADDRESS: 13507 NW WAX MYRTLE TR. PERMIT #:
PALM CITY, FL,
MANDATORY REQUIREMENTS SUMMARY - See individual code sections for full details.
COMPONENT
SECTION
SUMMARY OF REQUIREMENT(S)
CHECK
Air leakage
402.4
To be caulked, gasketed, weatherstripped or otherwise sealed.
Recessed lighting IC -rated as meeting ASTM E 283. Windows and
doors = 0.30 cfm/sq.ft. Testing or visual inspection required.
Fireplaces: gasketed doors & outdoor combustion air. Must complete
envelope leakage report or visually verify Table 402.4.2.
Thermostat &
403.1
At least one thermostat shall be provided for each separate heating
controls
and cooling system. Where forced -air furnace is primary system,
programmable thermostat is required. Heat pumps with supplemental
electric heat must prevent supplemental heat when compressor can
meet the load.
Ducts
403.2.2
All ducts, air handlers, filter boxes and building cavities which form the
primary air containment passageways for air distribution systems shall
be considered ducts or plenum chambers, shall be constructed and
sealed in accordance with Section 503.2.7.2 of this code.
403.3.3
Building framing cavities shall not be used as supply ducts.
Water heaters
403.4
Heat trap required for vertical pipe risers. Comply with efficiencies
in Table 403.4.3.2. Provide switch or clearly marked circuit breaker
(electric) or shutoff (gas). Circulating system pipes insulated to =
R 2 + accessible manual OFF switch.
Mechanical
403.5
Homes designed to operate at positive pressure or with mechanical
ventilation
ventilation systems shall not exceed the minimum ASHRAE 62 level.
No make-up air from attics, crawlspaces, garages or outdoors adjacent
to pools or spas.
Swimming Pools
403.9
Pool pumps and pool pump motors with a total horsepower (HP) of =1
& Spas
HP shall have the capability of operating at two or more speeds. Spas
and heated pools.must have vapor -retardant covers or a liquid cover or
r
other means proven to reduce heat loss except if 70% of heat from
site -recovered energy. Off/timer switch required. Gas heaters minimum
thermal efficiency=78% (82% after 4116113). Heat pump pool heaters
minimum COP= 4.0.
Cooling/heating
403.6
Sizing calculation performed & attached. Minimum efficiencies per
Tables 503.2.3. Equipment efficiency verification required. Special
equipment
occasion cooling or heating capacity requires separate system or
variable capacity system. Electric heat >10kW must be divided into two
or more stages.
Ceilings/knee walls
405.2.1
R-19 space permitting.
°/201201310.40 AM EnergyGauge® USA - FlaRes2010 Section 405.4.1 Compliant Software Page 5 of 5
0
vim✓ 1/ V \ - _ .
Job #:
Performed for:
RALPH PATONY
13507 NW WAX MYRTLE TR.
PALM CITY, FL
i
QUICK CALCS, INC.
317 ST. LUCIE LN.
FT. PIERCE, FL 34946
Phone: 772-466-6799 Fax 772-4664M
61UICKCALCS@AOLCOM
Scale: 1 : 51
Page 1
Righ4SuileS Unhersa12012
12DD7 RSU08101
2013-May-2010.42:54
lightsoRHVACTATONYRALPH rup
5/22/13
Ralph V Patony Record: I of 1
Property Identification
Site Address: 13507 NW Wax Myrtle Tr
Sec/Town/Range: 36 :37S :40E
Map ID: 44/36N
Zoning: PUD
PropertyAppraise SLLucieCourm, FL
PROPERTY RECORD CARD -
<<Prev Next» Spec.Assmnt Taxes
Ownership and Mailing
Owner. Ralph V Patony Nicole Parony ~
Address: PO Box 2001
Point Lookout NY 11793
ParcelID: 4436-601-0022-000-6
Account #: 119527
Use Type: SF Res
City,'Cnty: St Lucie County
Exemptions Permits Horne Print
L � f
Legal Description
HARBOUR RIDGE PLAT NO 1 LOT 22 (OR 3435-2876)
Salts Infunnation
Assessment 2012
Total Land and Building
Date
Price
Code
Deed
BookTage
2012 Final:
569500
Land Value: 225000 Ades: 0.61
9/8/2012
765500
0001
WD
3435 ,•• 2876
Assessed:
569500
Building Value: 344500
1/18/2002
811800
00
WD
1482 / 1467
Ag.Credir.
0
Finished Area: 3148 SgFt
5/5/1999
749000
00
WD
1222 / 1294
Exempt:
6111/1995
415000
00
WD
0958/2365
Taxable:
7/1/1984
75000
00
CV
0439 / 0785
Taxes:
11521.74
BUILDING INFORMATION
Exterior Features
View:
-
RootCover.
CT -Cone Tile
RootSttuct:
HP - Hip
ExtType:
HA+ - HA+
YearBIt:
1986
Frame:
-
Grade:
A+ -A+
EtlYrBlt:
2000
PrimeWall:
CB - CedarBd/Btn
StoryH,ght:
0010 - 1 Story
No.Units:
1
SecWall:
-
Interior Features
B edRooms:
3
Elecuic:
MX - MAXIMUM
Prmintvrall:
DW - Drywall
FullBath:
3
HeatType:
FHA - FrcdHoLAir
AvgHt/Fl:
1 /2Bath:
1
HeatFuel:
ELEC - Electric
Pmr.Flors:
HW - Hardwood
%.A/C;
100
"/Xcated:
100
"�uSprinkled:
0
Special Features and Yard
Items
Land Information
Type
Y/S
Qty.
Units Qual.
Cond.
YrBlt.
No. Use Type
Type
Measure Depth
ENC2 - POOL ENC-AVG
Y
1
1162 AV
AV
1986
1 0100-SF Res
GFI -Site
1
PA01 - POOL DK AVG
Y
1
644 AV
AV
1986
SWAV - RES POOL AVG Y
1
500 AV
AV
1986
SPA - SPA -HOT TUB
Y
1
18 AV
AV
1986
PHTR - POOL HEATER
Y
1
1 AV
AV
1986
DWCS - Driv-StmpCon Y 1 1520 AV AV 1990
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
COUNTY
F L 0 R I D
RECEI rCMxf 2 6 2016
PLANNING AND DEVELOPMENT SERVICES DEPARTNMT,
BUILDING ANO,ODDE REGULATIONS DIVISION
2MVMGINUAVE
FORT PIERCE, FL34982.
(772) 4624553 Fax (772) 462-ISM
,PEMHTRENEWAL REQUEST
- I _r
PERMrr NUMBIUL 056�2.1, ADDRESS.- LA'� L�X)a�34
C/
1�eodcre,_. am requesting pengthatthe�above rmitberenewp&.1
�dtandbatbiiust schedule and�,I*ss'afl mqm'red inspections for the permitto bpfinolpd. 'Furtherl
unOmta!ad.&A--tthis -is.a:ONKTIME RENEWAL and the p-emitshall :expire a
passinginspecition dLWttg any six-month period during -the renewal period.
Justification. Aagroa I05GEC .P100, -wi%
v
0"ER/BLDR,gM,C0M'RACTQR SIGNATURE DATE
Print Name
STATE OF
COUNTY L
ACKNQWI,EDW BEFORE METHIS 2&_A-DAY OF 004aA-i- .20
,BY ��eodcre__Mann WHO IS PERSONALLY KNOWN TOME
HAS PROVIDED ASMENTIFICA11OK:
TE'OFFLORIDA. Cmm.kyot U461�e.
SIGNATUREOFNMARY
All
"A ve
FOR OFFICE USIC ONLY:
Number of Open Inspections:
Totalimlm-hons;
(Divide open by total to ga% or()P= inspections)
Pormemp: -1 S
orighw1perilwitAw .1 x%opm . �,RenewW fee
Hxjm*1et:, (15divided by23=.65(%)1$175(pennit.6* . ) *.§54113.75 (renewal fee)
Rcyind 71211=14
USS15LL
W of Florida
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