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HomeMy WebLinkAboutBuilding Permit Applicationf -/ ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:~Permit Number:__+1"",_-_ Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax:(772)462-1578 Commercial ----Residential ---- LK-A (0133 Lot No.33 Block No._A__ Property Tax ID #:---'-=.!='---~~'---~...L!....!..<!...--==:::'='-=----=:::~_ Site Plan Name:~------------------ Project Name:_ Setbacks Front._Back:Right Side:Left Side:_ o Windows/Doors DRoof Total Sq.Ft of Construction:_---,,..--_ Cost of Construction:$If'2cQ~ S~of First Floor: Utilities:USewer D Septic Building Height:_ NameHtf 7~-hes OCt.JCI%S ~~'Bu,ler Address,25'1 ca:m ,;'D laxes Gr'ele.- City:rt3t2~f!A;-/-on State:FL Zip Code:d3Y£Co Fax:._ Phone No.&1-122-Ofa52 E-Mail:_ Fill in fee simple Title Holder on next page (if different from the Owner listed above) Company:C of-lh<.sure Address:I.aO!:;.;';?rI(Jr~d 1I&ute. City:f-tJef I-erce.State:~ Zip Code:.:3'ItJ~2..Fax:1'lJ -'Ihf).--'fCJ£fr Phone No.17c2-t/h 0:/6cto E-Mail:ad(anlaqq;et2mlfs ~~'/.~ State or County License:tilt!o>i466-e If value of construction is $2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION':.".•'<)::;<5',., DESIGNER/ENGINEER:_Not Applicable MORTGAGE COMPANY:_Not Applicable Name:Name: Address:Address: City:State:City:State:-----Zip:Phone:Zip:Phone: FEE SIMPLE TITLE HOLDER:_Not Applicable BONDING COMPANY:_Not Applicable Name:Name: Address:Address: City:City: Zip:Phone:Zip:Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St.Lucie countfi makes no representation that is granting a permit will authorize the germ it holder to build the subject structurewhichisinconlictwithanyapplicableHomeOwnersAssociationrules,bylaws or an covenants that may restrict or prohibit suchstructure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review:room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite before the first inspection.If you intend to obtain financing,consult with lender or an attorney before commencing work or recording your Notice of Commencement. IV'<~/-;7.iJ~~l~IVJ~'_n.7td~~.. r ~gr(ature of Owner/Agent/Lessee VS'ignature of Contractor/License Holder STATEOFFlORI~'f LC!Ct~STATE OF FLORIDA ~'-1 Ltrf;GJCOUNTYOF'--s:COUNTY OF '<;(}an The ~g ins~~was aCknOWledgrlifefore me The for~ing instr/1fnt.w/s acknowledged before methisayofCII,20 n by this 27 day of /21 ,20rm by Gmf/el To hlLrhoRU'()~CJ!lt11uei T "-VI-hILI){ (Name of person acknowledging)"-(Name of person acknowledging) /p.I2-X\\\\UII')f11 L~yC?a_~Aj_',,,~Jh .;:;II~\\lilll/II/I, (Signature of Notary ~i-~~~f§f Fr6f~(Signature of Nota 7C-Stat£'$~:i.!tiJ.l ••-:-'!:~. ~'l.\J\{:.\Y~~~.·~'j..PIAES".~0 Personally Known 7 if!kfp:profj~"l=d!~~@:ication Personally Known t o~@~~~tlkntifici\i~~"-III ~..c~.\_---Type of Identification Producciilw :52 ~III '"'i~'':k::;Type of Identificatiolt C't;d.~i~:~=: ~£\9,~It G#q;:~:""0i ::z:~~~.;~j}U,:~•-(It '~~--.O~<:::).1-..-.Commission No.~<:...,,~.':ii)Commission No.~.a:_.(,)~(~~:~~ $)•.'i'S x-~·~.-(4 ,~0··:§.~•••••••:'\«~.:;:. '11111,/NOTt<~\\\.,\,~~...~~,:.o~~ ~••••••••~f"..\~'"~ ""111.,/,~l!.TP.~,\\,.... Revised 07/15/2014 1IIIII/Hlill'" REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVECOUNTERREVIEWREVIEWREVIEWREVIEWREVIEWREVIEW DATE RECEIVED DATE COMPLETED Ii ""·i~A.~~1CERTIFIED® ~~~.,C'~.www.ahridirectory.org ~':.'i'~~ Certificate of Product Ratings AHRI Certified Reference Number:8457842 Date:4/27/2017 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:TC4B4221 Indoor Unit Model Number:AP42CX21+TXV Manufacturer:CHAMPION BY JOHNSON CONTROLS Trade/Brand name:CHAMPION HEATING AND COOLING Region:Southeast and North (AL,AR,DC,DE,FL,GA,HI,KY,LA,MD,MS,NC,OK,SC,TN,TX,VA AK,CO,CT,10,IL,lA,IN,KS,MA,ME,MI,MN,MO,MT,NO,NE,NH,NJ, NY,OH,OR,PA,RI,SO,UT,VT,WA,WV,WI,WY,U.S.Territories) Region Note:Central air conditioners manufactured prior to January 1,2015,are eligible to be installed in all regions until June 30,2016.Beginning July 1,2016,central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. Series name:LX SERIES Manufacturer responsible for the rating of this system combination is CHAMPION BY JOHNSON CONTROLS Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored,independent,third party testing: Cooling Capacity (Btuh): EER Rating (Cooling): SEER Rating (Cooling): lEER Rating (Cooling): 40000 11.50 14.00 •.Ratings followed by an asterisk e)indicate a VOluntary rerate of previously published data,unless accompanied with a WAS.which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate Can be verified at www.ahrtdlrectory.orgcuck on "Verify Certificate"link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. ©2014 Air-Conditioning,Heating,and Refrigeration Institute AIR-CONDITIONING.HEATING, &REFRIGERATION INSTITUTE ~ERTIFICATE NO.:131377868861415060