HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CA7 D04/1 Permit Number:
S cI 1C21-
sir
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_
Address ZuDnoi \j
Legal Description: LI A 61V i CflA MhYb 1lni ' IU+ 14'CI f 5104 - IG Pti_
Property Tax ID #:21 f ' (! ( a - D ham,- [ a- _ Lot No.A
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION Of WORK;
AC mncr ct+, 1t a foo- li Y -C) CIumpOn � _PC�CA u ni
3' 5 tan Iq, Y, -V 40 Y -LA) VWW.
CONSTRUCTION INFORMATION.
Aaditional work toe nertormed under this permit - check alf that apply:
HVAC 0 Gas Tank ❑Gas Piping _ Shutters Windows/Doors
0 Electric E] Plumbing Sprinklers I Generator 1:1 Roof O Roof pitch
Total Sq. Ft of Construction: Sq_ Ft. of First Floor:
CD
Cost of Construction: $ �JO .-� UtilitiesoSewerE]Septic Building Height:
OWNER/L.ESSEE.
CONTRACTOR.
Name
Address: 3 Omm 9W6
Name., 2,8M 1 I
Company:
City: _oi State: dill}
Zip Code: ol jji k Fax: N
Phone Na��l'I
Address: LON
City: C
p State: �
Zip Code:._34A L Fax .s �Q
Phone No. 41ob- It an(
E -Mail: N
Fill in fee simple Title Holder on next page (N different
E -Mail: i
from the Owner listed above)
State or County License:
�� "Mu W9 w1911Auw16%wil fs fie_, 1Vv VT more, a KtLVKutu imolice oT Lorn tencemeCit i5 required.
"SI�PP��ENTAL CONSTRUCTION LIEN iAVI! tN�QRMAT'aC3iV'
EiESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City=
Zip: Phone
State:
City:
Zip: Phone:
State:
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 5t_ 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 work or recordingour Notice of Commencement.
Zip: Phone-
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of contractor/License Holder
STATE OF FLORIDA -
COUNTY OF �
STATE OF IFi.O A
COUNTY OF � . � -
Lk
MANGROVE
The forgging instrument , as acknowledged before me
2���.�evyy�'day
The f�org�ing instrument was acknowledged before me
REVIEW
REVIEW
this of 26f-> by
this day of 2r01 6y
REVIEW
DATE
�^
Name of person making statement
Name of person making ement
RECEIVED
Personally Known �` OR Produced Identification
Personally Known. OR Produced Identification
Type of Identification
Type of Identification
DATE
Produced
Produced
1�
(Signature of {Votary
(Signature of Notary Publi
�•....,•..: NAM. HILL
Commission N C4i�N#GG 099038
��
tXP ES:
DONNA M. HILL
Commission N • ',�= MY SIGN#GG 099038
.•„� ���:,4pri130,
pri130, 2021
'' ° ;; �•• Bonded 7hna Notary Public Uaderw�iters
�.. 2021
Bt>nded Tt��u NuiEry Pub6ic Undelwritters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
Rev. 8/2/17
"SI�PP��ENTAL CONSTRUCTION LIEN iAVI! tN�QRMAT'aC3iV'
EiESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City=
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
� Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
City:
Zip: Phone:
Zip: Phone-
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Certificate of Product Ratings
AHRI Certified Reference Number: 8560560 Date: 04-02-2018 Model Status: Active
AHRI Type: SP -A
Series: LX SERIES
Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING
Outdoor Unit Model Number (Condenser or Single Package) : PCE4A24*
Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, Hl, 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 t, 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 ANSIIAHRI 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 : 23400
SEER: 94.00
EER (A2) - Single or High Stage (95F) : 11.00
1"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 -r
affeeing tar sate.
Ratin s that are ccom anied by VU indicate an involunta re -rate. The new published rating is shown alona with the orevious i.e. WAS ratio -
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 prodtict(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
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, 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.ahridirectory.org, click on "Verify Certificate" link
and enter the AHRI Certified Reference Number and the date on which the certificate was issued, we make life heifer
which is listed above, and the Certificate No., which is listed at bottom right.
®2018Air-Conditioning, Heating, and Refrigeration Institute I CERTIFICATE NO.: 1 31 671 627 56 891 27 52