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HomeMy WebLinkAboutPermit App ALL APPUCABl.E iNF )(MUST BE COMPLETED FOR APPLICATION TO o BE ACCEPTED Date: Le �1 Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)452-1553 Fax:(772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPRE VEMFN.7`LOCATIDN . Address: L?©m� 1(&�o 6. S Legal Description: 110m--&QUA um f 5 P122 -VaRA &�aL .n bf, 4bL11J Property Tax ID#: I f'b�2�J" Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back Right Side: Left Side: DETAILED DESCRiPTIflN flf= C?t3K G Ch . p" 4; IXt,) DYE J iCz4 Z4-ZI ; c5M-7 tr, " t-r j C£}NSTRUCTIO IN.I=QRMATI:t U.N: Additional wor to bane rmed under t is permit—c ec all apply, r OHVAC Gas Tank QGas Piping _Shutters D Windows/Doors 11 Electric Plumbing OSprinklers El Generator O—Roof Roof pitch Total Sq.Ft of Construction: S .Ft.of First Floor. Cost of Construction:$ 4 = Utilities: Sewer 05,eptic Building Height: OWN ERf ER/LESSEE. _ CONRACTOR Name Name: SOMO Address: kr- Company: City: (, II State:C- Address. Ubt ` Zip Code: ' ` Fax:t4 l City: I _ State: tt � Phone No. Zip Code: ft Fax E-Mail: Phone IV,. -tuak Fill in fee simple Tate Holder on next page(if different E-Mail: from the owner listed above) State or Countv License:_ .h3 U le 4'` If vaI a of construction Is$25M or more,a RECORDED Notice of Commencement is required. �SIyTRP-�M� �'AL L'Q'#V�T�UCTIQ�}C�EE�f-kA1 �N�f3�MAT14N - DESIGNER/�ENGINEER: Not Applicable MORTGAGE C©11i1PANY: Not Appli[able Namt=• Name: Address: Address: City: State: City: T State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Name- 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 worts or installation has commenced prior to the Issuance ofa permit. St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structu re 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 frill 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 our Notice of Commencement. _ 7 r 7 a::�4 Signature of Owner/1_6seeJContractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA - STATE OF FLQ A COUNTY OF COUNTY OF f—_ The forgoing in ent was acknowled ed efore me The fo oin instru ent was ar_knowled a efore me this day of -t _ ems.2[3. by this day of .20by 1 � 1 � Is . Name of person malting statement Name of person making statement Personally known_�_OR Produced Identification Personally Known. X Oil Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary t (Signature of Notary Pubti r •"•.,': iM LL ONNAM.H1LL Comrrtission N CQ � GOgg038 Cominission{� fi10N#GCi099U38 (PS Apriil 30,2o29 ,202Etlndettivded3rtrNataryPubfii ElnGenvtlers REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.81 2/17 i or y.A rg Certificate of Product Ratinqs AHRI Certified Reference Number: 10203592 Date:06-27-2018 Model Status:Active AHRI Type:RCU-A-CB Outdoor Unit Brand Name:CHAMPION HEATING AND COOLING Outdoor Unit Model Number (Condenser or Single Package):TC4132421 Indoor Unit Brand Name:ADP Indoor Unit Model Number(Evaporator and/or Air Handler):SM7(6,9)24+TD 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,1L, 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 ADP product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of ANSIIAHRI 210I240 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:22000 SEER:14.00 EER(A2)-Single or High Stage(95F) : 12.20 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 by WAS indicate an involun re-rate. The new published ratino is shown along with the previous 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 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.ahridlreetory,mg. 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, Arm WWW 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 we snake 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. 9)2418Air-Conditioning, Heating, and Refrigeration Institute LCERTIFICATE NO.: 131745872036674040