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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 6 " ^4- at)I B_ Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginio Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential PERMIT APPLICATION FOR: AI a b PROPOSED INPROVEMENT LOCATION: Address: liDs i 6 V::Po'=; [ 7'tzCLP_ Legal Description: 1 P4! S Property Tax ID 4: 34 15 - 71 C) s - t7O t o - Ono - 3 Lot No. E5 Site Plan Name: Q_> l?g Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: I CONSTRUCTION INFORMATION: Additional work to be pertormed under this permit - check all that apply. vlechanical _ Gas Tank _ Gas Piping Electric _ Plumbing _ Sprinklers Total Sq. Ft of Construction: 1 Q>4lo Cost of Construction: $ L OSO Shutters _ Generator Sq. Ft. of First Floor: Windows/Doors Roof Utilities: _ Sewer _ Septic Building Height: OWN ER/LESSEE: CONTRACTOR: Name 1" A(z l r-_- 1. o GeJQ Z Na me: C,.Qtl- L G e sr -4 `v2sa (fes Address: i- S l t-, y5 Company: t r-- L_ 2_ � l v -(`bp_=,� City: p"_ ';; 6-T • Luca e, StatcPC- Zip Code.540ISZ Fax: Phone No.Q (op - 1�rj (� Address: 15'1 1 City: Pm fi ST' L.-Wtai;_� Zip Code: Qt( 3 Phone No. ---t - i E -Mail: State or County License -.-c. %), 01i1 State!�'C_.. Fax: -�-- t _ 34 t �S ISN L9kq63 9 E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) It value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION UEN LAIN IN f ORMATION: 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: Address: BONDING COMPANY: _Not Applicable Name.- ame: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. 712014 Signature Owner/ Agent/ Lessee Signature of Co or/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF. COUNTY OF �LUCJ u;- _SThe Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this4 day of`� t - JAS 201 Eiby this Xday of 7:51-ni eJ 20�by (Name of person acknowledging (Signature of Notary Public- State of Florida ) (N er ) (Signature of Notary Public- State of Florida) Personally Known OR Produced Identification Personally Known A R1I=8E4L ur l�ca j at FW141 Type of Identification Prod e Type of Identification PVV 9 SHAWN A RUSSELL .1,µr gape.,,• Commission No. � : � � •. Notary Pu�lfieaqtNe Ot FbrWt =_' Commis,ion No, �, C0 Mar 11, 2020 Nelny Assn. • __ commissbn / FF 959999 900 oma: g Mar 11, 2020 "' ,9'„;•``' Bonded through Notary Attu. REVIEWS R PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 712014 Certificate of Product Ratinas AHRI Certified Reference Number; 202067943 Dale : 06-04-2018 Model Status: Active AHRI Type: RCU-A-CB Series: ELITE XC16 SERIES Outdoor Unit Brand Name : LENNOX Outdoor Unit Model Number (Condenser or Single Package) : XC16S036-230A" Indoor Unit Model Number (Evaporator and/or Air Handler) : CBA27UHE-042-230'+TDR 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 : 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 LENNOX 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 : 36000 SEER: 16.00 EER (A2) - Single or High Stage (95F) : 12.50 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. "Prod uction 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 previous (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 v�ww.ahridlrectory.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, personal and confidential reference. AIR-CONDITIONING. HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at :;ww.ahridirectory.org, dick on "Verify 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. 131725938108714967 ©2018Air-Conditioning, Heating, and Refrigeration Institute j CERTIFICATE NO.: