HomeMy WebLinkAboutBuilding Permit ApplictionALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
J
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 F '
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
-DETAILED DESCRIPTION OF WORK:
Lot No._
Block No.
b
CONTRACTOR:
Name
_a
Add re s:
Company:``
=CONSTRUCTION INFORMATION:
itiona wor to jeer orme un er t is permit . cec a apply:
` VAC l� Gas Tank ❑Gas Piping _ Shutters
' a Windows/Doors
Electric ❑ Plumbing Sprinklers ❑ Generator 0 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ (n'-1 �
S Ft. of First Floor: _
Utilities:In Sewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: `
Add re s:
Company:``
City: Stater
``GG
Address: X10 cy
`7��1
Zip Code. ax:
City:
Stater
2
Phone No._a
Zip Code: _<5L-
Fax:
,�
E -Mail:
Phone No.
E -Mail: 1
' 1
— 71`�
1 e C
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:��
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Cont�tor7License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF (1(� �
COUNTY OF�(�
The fqrgoing instrument wa acknowledge¢ before me
The figrgoing instrument was acknowledge before me
this y of 20 by
thi day of Y , , 20by
( c
Name of person making statement
Name of per on making statement
Personally Known � OR Produced Identification
Personally Known � OR Produced Identification
Type of Identificatio
Type of Identification
Produced
Produced
(ignature of Notary Public- State of Florida)
(ignature of Notary Pub ic- State of Florida )
Commission No. —,
Commission No. �: _iC� (Seal)
Florida
Stats t Florida
R I oto %der ZONING SUPERVISOR
�q
Noelle Sny er
PLAN G�TAt�ti3Nnl ° 1LE MANGROVE
/ o t
WG RM9kW REVIEW
RE a /I iresoBJo V E REVIEW
DA �' xpr
REC IVE
DATE
COMPLETED
Rev. 8/2/17
Certificate of Product Ratinas
AHRI Certified Reference Number: 9100308 Date : 04-30-2018 Model Status : Active
AHRI Type: HRCU-A-CB
Series : LX SERIES
Outdoor Unit Brand Name: JOHNSON CONTROLS
Outdoor Unit Model Number (Condenser or Single Package) : YHE18B21
Indoor Unit Model Number (Evaporator and/or Air Handler) : AP18BBA21
The manufacturer of this JOHNSON CONTROLS product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 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 : 17800
SEER: 14.00
EER (A2) - Single or High Stage (95F) : 12.00
Heating Capacity (H12) - Single or High Stage (47F) : 17500
HSPF (Region IV) : 8.50
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.
Ratings that are accompanied by WAS indicate an involuntary re -rate. The new published rating is shown along with the Drevious (i.e. WAS) rating
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
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,
which is listed above, and the Certificate No., which is listed at bottom right.
C2018Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.; 131695801666111718