HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Nunbtit
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address:
L I Descri t'on:
,7
Property Tax ID #:
Site Plan Name.
-
Lot No.
Block No.
Project oi
ect Name: 1 0
Setbacks Front Back: Right Side: Left Side:
DETAILED IP Io WORK
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CONSTRUCTION INFORMATIONS
'Additional work tobe Ljq--rtormed under this permit z��7_cffekk a tbal apply:
OHVAC ID Gas Tank ❑Gas Piping Shutters Windows/Doors
I]- Electric Plumbing Sprinklers Generator Roof I I Roof pitch
Total Sq. Ft of Construction: Sc,. Ft. of First Floor:
Cost of Construction: $ "75 2 5 0 0 0 Utilities: Sewer Septic Building Height:
OWNER/LE'SSEE: CO-NTRACTOR.-
Name Narne: Ur
Vic
Address: Company: e��f� Sew- -e, LL -(-.-
city: State: f Address.CoLn
Zip Code: '��A '-1 Fax: City: Por4 J-jj C Le- —State:
Phone No. S 4=2, Zip Code: 3q Fax:7?Q__'cj3q _3!Sjj
E -Mail:
Por e No. '7'IZ-- V71 -bW
Pill in fee simple Title Holder on next page (if different E -Mail: 146
from the Owner listed above) State or County Ucense: C.K, I
If value of construction is $2500 or more,, a RECORDED Notice of Commencement is required.
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
zip: Phone:
BONDING COMPANY:
Name:
Address. -
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
41
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
commen6n-3t,work or r-ecordime your Notice of Commencement.---_._
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature oT Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA --n
COUNTY OF COUNTY OF ro- S4. 2-ilcl-c"
The forgoing instrument was acknowledged before me
this day of aL) 20 I by
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
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(Signature , f,„Nota ry Public- State of Florida
RVV k
J 01- 0 01
NEVIS r.
RC 't1VE D
DATE
COMPLETED
Rev. 8/2/17
Seal)
Mori$ SOuchard
%!NUM GO 179653
:7' FRONT ZONING
COUNTER REVIEW
The forgoing instrument was acknowledged before me
All -
this. --E day of J L) 20.� by
n
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
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Linda Marie Bouchard
Co N*!s 1+C Y COMMission GG 179653
0572 172022
SUPERVISOR I PLANS I VEGETATION
REVIEW REVIEW REVIEW
4-1
SEA TURTC,),:.,,-'MANGROVE
REVIEW RE')'Af,*
This combination qualifies for a Federal Energy Efficiency tax Credit when
placed in service between Feb 17,2009 and Dec 31, 2016.
AHRI Certified Reference Number: 8676069 Date: 06-05-2018 Model Status : Active
AHRI Type: RCU-A-CB
Series: SILVER 16
Outdoor Unit Brand Name: AMERICAN STANDARD
Outdoor Unit Model Number (Condenser or Single Package): 4A7A6049J 1
Indoor Unit Model Number (Evaporator and/or Air Handler): TEM4AOC48S41 +TDR
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 AMERICAN STANDARD 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 : 46500
SEER: 16.00
EER (A2) - Single or High Stage (95F) : 13.50
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. , � 1 1 �
Ratio s that are acco�l I :)ani WAS indicate an in t re -rate. The new ublished ratio a is shown almQuith the
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
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and dim
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, HEA iNG,
CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE
The information for the model cited on this certificate can be verified at www..qhr10ivaotrwry.Qrg, click on "Verify Cortif !auto" linkwe niake fife 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.: 131726832328125770