HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / Permit Number:
i
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
Address: P)T� Kyv.�)'?�.
Legal Description: L
Property Tax ID H: `7 00 00 0 r Lot No,
Site Plan Name: Block No.
i ^0 H 0_"'
Project Name: psujlzarp
Setbacks Front U Back: Right Side: Left Side:
�TAILED DESCRIPTION OF WORK:
CONS UCTICIN INFORMATION.
dti na work to e e orme under this permit check a app y:
_ HVAC Gas Tank ❑Gas Piping _ Shutters ❑Windows/Doors
❑ Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ _ , �V 00 Utilities:D Sewer Septic Building Height;
OWNER/LESSEE:
CONTRACTOR:
Name �, J iti
Name
V
Address:
City: State: �
Zip Code: 0,3 Fax: N M7
Phone No. ts- �
E -Mail: N IA
Company:
Address: QHS
City:
Zip Code:��q�
Phone No. ]j
State:
Fax:lp--d�'�j��f1
1-7 Q
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E -Mail;
!_
T
State or County License:
0_AC Q5`LLAo
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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.
Rev. 8/2/17
Si a e of owner/ Lessee/Contractor as Agent for owner
Si' re f Contractor/License Holder
STATE OF FL
STATE OF FLOIVCAf�
COUNTY OF'1�
COUNTY OF
The forgoing instru en w s acknowledged before me
acknowledged before me
The forgoing instru mar?
this l day of 2.0_ by
this i day of V,� 20 by
u v
U �e VUR. r
Name of per making statement
Name of pers making statement
Personally Known OR Produced Identification
Personally Known ' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signet }
leum PAL
(Signature
-
_
. = My+Abtl i 5th .5323
ALEXIS ROVIV R
Commis ` MY er'Qd[sV-al):
Commissio
= MY CC3MMlSSIgId # G�g�g �3
EXPIRES Jul 20 121
i
',' �, ,: EXPIRES July 20, 2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
This combination qualifies for a Federal Energy Efficiency tax Credit when
placed in service between Feb 17,2009 and Dec 31, 2016.
Certificate of Product Ratings
AHRI Certified Reference Number ; 201294083 pate : 03-01-2U18 Model Status : Active
Oid AHRI Reference Number :7943535
AHRI Type : RCU-A-CB
Series :
Outdoor Unit Brand Name : RHEEM
Outdoor Unit Model Number (Condenser or Single Package) : RA1648AJ1
Indoor Unit Brand Name .-
Indoor
Indoor Unit Model Number (Evaporator and/or Air Handler) : RH1T4821 STAN
Furnace Model Number :
Region : All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, 1N, 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.
The manufacturer of this RHEEM product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSI/AHRI 2101240 with Addenda 1 and 2, Performance Rating of unitary Air -Conditioning
& Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing:
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 45000
SEER :16.00
EER (A2) - Single or High Stage (95F) :13.00
IEER
t"Active° Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale: OR new models that are being
marketed but are not yet being produced "Production Stopped" Madel Status are those that an AHRI Certification Program Participant is no longer producing BUT is still
selling or offering for sale.
Ralinrrs that are accompanied by WAS indicate an involuntary re -rate. The new published rating is shown along with the previous (i.e. WAS) ratina.
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 th Is Certificate. Certified ratings are valid only for models and configurations listed in the
directory at www.ahridirectery.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personalantl
confidential reference purposes_ The contents of this Certificate may not, in whale 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-CONornONING, HEATING,
CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE
The information forthe model cited on this certificate can be verified atwevw.ahridireetnry.org, click on "Verify Certificate" link wo-„ahelifi bent--
antl 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.
02018Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131643928656014495