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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 3` Z'6i 2-16 Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce Ft 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 IOCATI`QN: Address: Legal Description: � ✓ , Property Tax ID #: 0� �� UU�4� �` l Lot No. �2.0 Site Plan Name: Block No. - Project Name: Setbacks Front Back: Right Side: Left Side: G Ghaorg- Dui l 01�u� ! e64C() 2.6 deer 5 tO n CONSTRUCTION _INFORMATION: -A-dditional work to be nertormed und& this permit - c ec a appy: HVAC Gas Tank DGas Piping _ Shutters windows/Doors LJ Electric ❑ Plumbing Sprinklers Q Generator LJ Roof Roof pitch Total Sq. Ft of Construction: Sq_ Ft. of First Floor: Cost of Construction: $ ° "'� Utilities: OSewer Eheptic Building Height: OWNER/LESSEE. ` CONTRACTOR: Name c, urA Mn Name: t T- Address: &Ij3 City:D ,+ t�4 State: T-1 Zip Code: 3-I-ci4u Fax: Phone No. M-4'01 _ 12� Q�) Company: T Address: Lf bt cS 4 City: �Q_* -I�State: � Zip Code: L Fa 5 Phone No E -Mail: N.1 la Fill in fee simple Title Holder on next page [ if different from the Owner listed alcove) E -Mail: i l State or County License:k�6cg Leif If value of construction is $2500 or more, a RECORDED Notice of commencement is requireo. "SUPPLEMENTAL CONSTRUCTION LIEN`LAW'INFORMATION: DESIGNER/ENGINEER; _ Not Applicable Name: MORTGAGE COMPANY: � Not Applicable Name: Address: City: State: Zip: Phone Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable Name: BONDING COMPANY: Not Applicable Name: Address: City: Zip: Phone: Address: City: Zip: Phone: OWNER/ CONTRACTOR AFIFIDVIT: 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. 5t. 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, waits, 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 rnrrimpnrinnr work- or rPr_nrdinir vnur Notice of Commencement. � van �-�3� •� /,; Signature of owner/ Le see/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA - COUNTY OF �' _ , s r� t'1k STATE OF FLO)WA COUNTY OF Thef rgoing instrument w s acknowledged before me this T3 day of r -.0h 20by The forgoing instrument was acknowledged before me this 2tL?;, day of t)T . 20A by Name of person making statement Name of person making statement Personally known _)S OR Produced Identification Personally Known _ OR Produced identification Type of identification Type of Identification Produced Produced (Signature of Notary 4 =•' tNAM. HILL •�,'CO (Signature of Notary Publi =',�-• "•_ /DONNA M. HILL Commission N ='¢ +s N # GG 099038 EXP _� MY SIGN # GG 099038 Commission N - =:A JIpril30, 2021 9onded Thru Nolary Publir Underwilters nl3 -�, � °g, P 0, 2021 Sanded Toru Notary Public Underwriters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE 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: 10225931 Date: 03-23-2018 Model Status : Production Stopped AHRI Type: RCU-A-CB Series: MOMENTUM Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING Outdoor Unit Model Number (Condenser or Single Package) : AL21 B6021 Indoor Unit Model Number (Evaporator and/or Air Handier) : AVV61 DE42+CC 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. 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 ANSWAHRI 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 : 52500 SEER: 20.00 EER (A2) - Single or High Stage (95F) : 13.00 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' Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratio s that are accom anied b WAS indicat an involuntary re -rate. The new Oublished ratina is shown alona with the Drevious Re. WASI ra in . 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.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and 81101 confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; irm" 111M entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the users 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.ahridirectory.org, click on 'Verity 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. ©2018Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131662924669903597