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HomeMy WebLinkAboutCHANGE OUT JOSTALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 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) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: � 0 6(qf( Legal Description: LIaYsfS AT PCA Vit(AFaE (pe q3-tj< A Lov'v of z (.1-200 Property Tax ID#: 333 "�-(D C-,Oq q-- jp- Site Plan Name: Lot No. Block No. Project Name: �0 Setbacks Front Back: Right Side: Left Side: DETAILED -DESCRIPTION OF WORK C awn . 0 0+ ; r' Con ci-)4coo-elr 4o c�_ 3.5 To rJ to Se r CONSTRUCTION INFORMATION: (itiona wor to jeer orme un er�isermit-c �eca�app,,r'��I�JHVAC LJ Gas Tank _ Windows/Doors Electric 0 Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: SFt. of First Floor: Cost of Construction: $�O . ( Utilities:11Sewer Septic Building Height: ht: _ OWNER/LESSEE: _ CONTRACTOR: Namet�c�, Name: Address:°IO�Q, rnonC �0..� Company:; p.eC r" . �'o��- S� .�C 1-2 ��(IC� City:LI`C, State: � Address: �?�� n_LC_) City: �'� ni i?"CPj�`� t Z loll j Zip Code: 3N M, (o Fax: �/� (S S ( , Phone No. 11 oZ - `� � �-�� � State: L- E -Mail: : J �UO� Zip Code411Fax: Phone No..J `7 a- g -71 S('OD Fill in fee simple Title Holder on next page ( if different E -Mail: 6ff,6 k�YrgG SC'j 1 from the Owner listed above) .�hiC ` State or County License: (k (n If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: _ Not Applicable Name: Address: City: State: 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: Name: _ Address: City:____ Zip: I certify that no work or installation has commenced prior to the issuance of a permit. Phone: Not Applicable 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 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 commencin rrorlror record�qr Notice of Commencement. _ Signature of Owner/ Lessee/Agent STATE OF FLORIDA STATE OF FLORIDA( COUNTY OF Pott S+,LLIL,t COUNTY OF `� !�4 , Limit , The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this L day of _ V arwe i` 20 1�by this /k day of _ -AV xw�-- _ 20 D -by (Name of person acknowledging) (Name of person acknowledging ) (Signature of Notary Public- State of Florida) '( Ig ature of Notary Public- State of Florida ) Personally Known '� OR Produced Identification Personally Known V OR Produced Identification Type of Identification Produced Type of Identification Produced I Commission No. Revised 07/15/2014 3980153 LINR"ARIE BOUCHAROIcommission No. �""'� ",,-LINDA MAI E�bUCHARD MY COMMISSION #FF125526II F'. , i �. �� MY COMMISSION #FF125528 398.0153 REVIEWS DATE COMPLETE FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW INITIALS This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2016. AHRI Certified Reference Number: 8703698 Date: 8/18/2017 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4A7A6042J1 Indoor Unit Model Number: TEM4AOC42S41+TDR Manufacturer: AMERICAN STANDARD Trade/Brand name: AMERICAN STANDARD 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, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, 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: SILVER 16 Manufacturer responsible for the rating of this system combination is AMERICAN STANDARD 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): 41000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 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 alteration of data listed on this Certificate. Certified 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 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. AIR-CONDITIONING. HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahrid irectory.org, click on "Verify Certificate" 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. `- - 131475429436718930 ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: