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HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number:' MIN 127 ,} Aw, L. 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 PERMIT APPLICATION FOR: PROPO, S'ED 1NR�R, ®VEI1/IE:NT LO�CA�TION � � ,,., :q '' Address: 0 e7 +� A Legal Description: t?GL Property Tax ID#: �� V Lot No. Site Plan Name: Block No. . I o4k Project Name: Setbacks Front Back: Right Side: Left Side: tint 11 INH:FQRM�AT1.®N: Additional work to be performed under this permit–check all that appy: Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ �` Utilities: —Sewer —Septic Building Height: 01NN'E�R LE�SEE . x Name Name: Address:' Z2 (J -S6:F hCte_JQ, S—r Company: - City:— I 7- _� State: Address: / Z • r Zip Code: 3 `f ' ' Fax: City: State: ` Phone No. ( Zip Code:_ S 3 • Fax: E-Mail: Phone No '72 Fill in fee simple Title Holder on next page (if different E-Mail iCZsl�4 !o from the Owner listed above) State or County License If value of construction is 2500'or more,a RECORDED Notice of Commencement is required. i S �''PLEIUIEN �►L CaN51'RtJCI'IC} LIEN L.AW [�N'FORMATI®N: . DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Ad d ress: 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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such structure. 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 andther"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 recordingyaVr Notice of Commencement. Signature of Owner/Lessee/. ntract r as Agent for Owner Signature of Contra r-/License Holder STATE OF COUNTY OF ciJ 1 COUNTY OFSTATE OF ORID:SP,4-C The forgoing instrument was acknowledged before me The forgoing instrument was a knowledged before me this 72 day of - 20_�2,by this-_-day of to3� 20 by (Name of person ac owledging) (Name of pers n know ledging) (Signature of Notary P lic-State of Florida) (Signature of Notary Public-State of Florida) ,o a y.ln FREt4NILL0 ' Personally Known �ouciV d Id Micas on Personally Known— Pro uce �a t IEL2� Type of Identification _; ¢�; afar u he ate e4ftefi�$ Type of Identification ;o4Pa� �s, •o •? Commisslon#FF 184850 ;s, Notary Public State of Florida Produced " " mm.Expires Dec 22,2018 Produced =•` ° •= commission#FF 184850 Bonded through National Notary Assn. ;91 ��;� My Comm.Expires Dec 22,2018 Commission No. Commission No. %°L���`� Bonded thr4i5o914lonalNotary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 4 i ion: an'Ift C E RT IFI E Do I www.ahridory.org Certificate of Product Rating' s AHRI Certified Reference Number: 9520645 Date: 8/8/2017 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number. PA14NC036*0'A* Indoor Unit Model Number: FB4CNF036L Manufacturer: PAYNE HEATING AND COOLING Trade/Brand name: PAYNE 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,ID,IL,IA,IN,KS,MA, ME,MI,MN,MO, MT,ND,NE,NH, NJ, NY,OH,OR,PA, RI,SD,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:.14 SEER AC Manufacturer.responsible for the rating of this,system combination is PAYNE.HEATING AND COOLING Rated as follows in accordance with AHRI Standard,210/240-2008 for-UnitaryI i%-Conditioning'and Air-Source HeatRunip Equipment and.subject to verification of rating.accuracy by AHRI sponsored,independent,;third party testing- Cooling Capacity(Btuh):' ` 33000 EER Rating(Cooling): 12.00 it SEER.Ratin Coolin = : '14=7 - 9.( , 9). IEER Rating(Cooling): Ratings followed by an asterisk(*)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 afieration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahrldirectory.org. TERMS AND CONDITIONS This Certificate and its contents are pioprietary 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;ori otherwise utilized,In any forth or manner or by any means,except for the user's individual, AM 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.ahrldlrectory.org,dick on"Verify Certiflcate"link we make life better- 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 I 131466660488607684 ! - ©2014 Air-Conditioning,HeatinIg,and Refrigeration Institute CERTIFICATE NO.: