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HomeMy WebLinkAboutCHANGE OUT GOLDSTEINALL APPLICABLE INFO MUST BE COP Date: FOR APPLICATION TO BE ACCEPTED Permit Number: 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 PERMIT APPLICATION FOR: To Address: Legal Description: %1La..f F(1,Fk-Jn Property Tax ID #:.14 Iq 5L(O-OZ73 Site Plan Name: Project Name: Ei o Setbacks Front Back: 78 Commercial Residential ect from dropbox, click arrow at the end of line �))((De, 401R -Z _ ( Lot No. Block No. Right Side: Left Side: MUUMunai worK 10 De DerTormed un HVAC 11 Gas Tank 11 Electric E-1 Plumbing Total Sq. Ft of Construction: Cost of Construction: $ lq-3a- Name_ n .Iqy ( Cl. S" Q! I n Address:_ &r)'14o( City: PcjC'i-Sf• �UCI-2 Zip Code: 3�1 qg3 Fax: Phone No. 5b E -Mail: Fill in fee simple Title Holder on next page from the Owner listed above) If value of construction is $2500 or more, a Gas Piping LiShutters ❑ Windows/Doors Sprinklers Generator Roof Roof pitch S Ft. of First Floor: Utilities:oSewer Septic Building Height: Name:-Dr��It!����f'►•- Company:vtteJLQ A{, State: EL Address: ,5'6 rn .r ra& ),, ,, LD p L 0_)I ) City: nh�t State: 4:::L - Zip Coder qq,,&P Fax: 7-7Q -1i3Ll -35 ) I Phone No. = ;Z -g71 - I S(00 different E -Mail: S)9e6-0Y7AC. S(f-rQ1(�cQ Ih-4IL U State or County License: 0-1gA 1- 11- 'C ) '7 / -) .-:1, DED Notice of Commencement is required DESIGNER/ENGINEER: — Not Applicable Name: Address: City: S ate.-_ Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: — Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: Not Applicable Name: Address: City: Zip: Phone: I certify that no work or installation has commenced prior to the issuance of a permit St. Lucie County makes no representation that is gri inting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owne s Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners sociation and review your deed for any restrictions which may apply. In consideration of the granting of this requested pi rmit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans, the Florida Wilding Codes and St. Lucie County Amendments. The following building permit applications are exen accessory structures, swimming pools, fences, wall: WARNING TO OWNER: Your failure to Reco improvements to your property. A Notice c before the first inspection. If you intend to commencigA! rK ft`or recordir�ceur Notio _ Signature of Owner/ Lessee/Agent STATE OF FLORIDA��� S+ COUNTY OF Lu_ The forgoing instrument was acknowledged before this 0 ( day of -N\) o , 20 Iby 1) oc& Ct 6 1 V -) C (Name of person acknowledging) 7 L (Signature of Notary Public- State of Flori Personally Known '� OR Produced I Type of Identification Produced it from undergoing a full concurrency review: room additions, signs, screen rooms and accessory uses to another non-residential use i a Notice of Commencement may result in your paying twice for Commencement must be recorded and posted on the jobsite )btain financing, consult with lender or an attorney before of Commencement. Signature of Contractor/License Holder STATE OF FLORIDA[') COUNTY OF1V I F The forgoing instrument was acknowledged before me this( -t day of -�-US�- 20 n by �� V I n 1' 1 1 i%1 �1-Pj� (Name of person acknowledging ) of Notary Public- State of Florida ) Personally Known !/ OR Produced Identification Type of Identification Produced Commission No. '""''"`; LIN"MARIE ° OUCHAR Commission No. �'"��° `• DA MALI 11ilbUCHARD t*! "i MY COMMISSI +�`'. #FF125526 F.;'` '1 i � MY COMMISSION #FF125526 Revised 07/15/2014 EXR MR (407) 398.0153 Floritlallotery ervlce.com 14o7)�3s8.01M Any 21, 201-13 FloridalloiaryService.com REVIEWS FRONT ZONING SUP RVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS A "IMF This combination qualifies for a Federal Energy t; NWILI CERTIFIED" Efficiency Tax Credit when placed in service r r r r between Feb 17, 2009 and Dec 31, 2016. Certificate of Product Ratings AHRI Certified Reference Number: 9438807 Date: 7/28/2017 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: PA1 6NA 024*0**A* Indoor Unit Model Number: PF4MNB0 5L Manufacturer: PAYNE HEATING AND OOLING Trade/Brand name: PAYNE HEATING ND COOLING Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, 4J, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY, U.S. Teri itories) Region Note: Central air conditioners anufactured prior to January 1, 2015, are eligible to be installed in all regions until June 30, 2D16. Beginning July 1, 2016, central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. Series name: 16 SEER AC - HIGH EE Manufacturer responsible for the rating of this system combination is PAYNE HEATING AND COOLING Rated as follows in accordance with HRI 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): 23600 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating (Cooling): Ratings followed by an asterisk (') indicate a voluntary rerate o previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certific ite and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disc aims 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. Cf rtified ratings are valid only for models and configurations listed in the directory at www.ahvidirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and AM confidential reference purposes. The contents of this Certif cate 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. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridlrectory.org, click on `Verify Certificate" link we make life better— and enter the AHRI Certified Reference Number and the d to on which the certificate was issued, which is listed above, and the Certificate No., which is liste at bottom right. T_ - " - _-- CERTIFICATE NO.: 131457388899 594985$5 ©2014 Air -Conditioning, Heating, and Refri eration Institute