Loading...
HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: JMIZ Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fork Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 452-1578 Commercial Y Residential PERMIT APPLICATION FOR: To Select from dropbox, clink arrow at the end of line PROPOSED IMPROVEMENT LOCATION. Address: _ MD Nmut S Legal Description: ,�Unrl SL Q2f V, W0 l PSI E.3 (VS �i__I. And -1 Property Tax ID #:� -- Vii i� (�a -D `L� Lot No Site Plan Name: , `�D Block No. � � /1 ._ ProjectName:�fz C%L rQl [r C,1� --� Je CAnC- — Setbacks Front Back: Bight Side: Left Side: I DETAILED DESCRIPTION OF WORK AG C,hCV1q . W+; +Dr t Mm o t) / CONSTRUCTION INFORMATION: itiona work to e e orme under tispermit–checka appy: HVAC 11 Gas Tank y Gas Piping _ Shutters F� Windows/Doors IJ Electric ❑ Plumbing O Sprinklers FIGenerator 0 Roof Roof pitch Total Sq. Ft of Construction: Cost of Construction: $ Sq. Ft. of First Floor: Utilities- 0Sewer 0Septic Building Height: OWNERf ESSEE:; CONTRACTOR: Namel"X hAgh I Vf la Name: irl�'iL41 • am Address. aS2 e {UiGIV �T Company:VOW W t1 CA City:XC Stater Zip Code: Fax.71))-4�?Gj- 5� R Phone N `�l 6i��14- Address: City:.--�- �i�� State:A Zip Code: � -'�r� l54a Fax:�`a' 5 4 Phone N .` ID W5_ I E-Mail:rY i-Wo,ibr�b �OLD bnh• Lor,n Fill in fee simple Title Holder on next page (if different from the Owner listed above) E -Mail: State or County Licens :.� 0112, .Q l,Q� It value of construction is $2500 or more, a RECORDED Notice at 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: Add ress: Address: City: Zip: Phone: City. 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. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA - I STATE OF FLOJU. CIA COUNTY aF)C�=" COUNTY OF_ � ~ e The f—oing instru lent wa5 acknowledgvbefore me this day of2 V1 Al MJ_20 by __Dw" t Name of person making statement Personally Known OR Produced Identification Type of Identification Produced y q4tt-i Thefnraoing instrument was acknowledged before me this _ _ day of _1�'V1i4�[�r L ti 26A by Ur M L Name of person making statement Personally Known _;� _ OR Produced identification Type of identification Produced L�, q)l (signature of Notary {Signature of Notary Publi �a DONNA M. HILL t ®0 NAM. HILL �= • MY SIGN # GG 099038 GG Commission N f , � N#GG 099038 Commission N P EXPES: pril 30, 2021: April 30 2029 '$ ; :�'��� Bonded Thru Notary Public Underwriters 's'%o : °•' Bonded Thru Notary Pubjc UnderWHters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 Certificate of Product Ratings AHRI Certified Reference Number :8459158 Date: 03-12-2018 Model Status :Active Old AHRI Reference Number : AHRI Type: RCU-A-CB Series : LX SERIES Outdoor Unit Brand Name : CHAMPION HEATING AND COOLING Outdoor Unit Mode[ Number (Condenser or Single Package) : TC4156021 Indoor Unit Brand Name : Indoor Unit Model Number (Evaporator and/or Air Handler) : AE60CX21+TXV Fumace Model Number : 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 i 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 CHAMPION HEATING AND COOLING 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 : 56000 SEER :14.25 EER (A2) - Single or High Stage (95F) : 12.00 IEER : 1F'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" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratinas that are acQQm anied b WAS indicate an involunta re -rate. The new ublished ratin is shown alongwith the revious i.e. WAS raf . 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. afg, TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and in be reproduced; copied; disseminated; Oman confidential reference purposes. The contents of this Certificate may not, in whole or part, enteredinto a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, AIR-CONDITIONING, HEATING, personal and confidential reference. & REFRIGERATION INSTITUTE CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link vve 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. ©2018Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.. 131653476428868730