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HomeMy WebLinkAboutUpdated Permit AppALL APP[.ICA,,B E IN `MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED UDate: Z� 1 6 Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34882 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 IMPIR-6VEMENT_LQC Ttt7lll .. Address: Lqoi 5 PropertyTax la #: ��7` " (i�� ?J- © Lot No. Site Plan Name: Block No. OWNER/LESSEE _. ` a"UNTRACTOIt: Name Name: Address-_5_1`, Company: City: State: C Address: " Zip Code: Fax City: f State: Phone No.]W- .WAIKe Zip Cade: Fax E -Mail: Phone N . E -Mail: Fill in fee simple Title Halder on next page ( if different from the Owner listed above) State or County Ucense: It value of construction is 525M or more, a RECORDED Notice of Commencement is required. uG��UNt>/ kI11GtNt:R: Not Applicable Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: Zip. Phone' W-0 MORTGAGE COMPANY: _ Not Applicable Name: Address: City: _ State: Zip: Phone: BONDING COMPANY: Not Applicable 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 worts or installation has commenced prior to the issuance alfa 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 Lune County Amendments. The following building permit applications are exempt from undergoing a Mull 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 tMce 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 tender or an attorney before commencing work or recording Your Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF The fo Ding In ent was acknowledged before me Name of person making statement Personally Known -- -)S _ OR Produced Identification Type of Identification Produced 7 Signature of Contractor/Ucense ST'ATEOFFLG A COUNTYOF U26C The forgoing Inst, ent was acimowledgedjoefore me- this��j,rday oft 20 b by Name of person making statement -� Personally Known �_ OR Produced _Identification Type of Identification Produced C�_ qy� -1AV_ _h (Signature of Notary t (Signature of Notary Publ ' �••�..� pp {1++ 9 M (*. HILL `/ u�y ijs ONNA iTr. HILI. Commission N �' COR'#GG0NW EXP Commission N ~. - M` IoN#GG099038 - ES: ,pri 3o, 2027 Bonded Thor Notary Pdit Widmviffm Apiii 30.2421 Tft Afoiary PU*Underwttl. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW RECEIVED DATE. COMPLETED Rev. 8/2/17 Ai66" Certificate of Product Ratinas 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) : TC4I32421 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, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT, VT, WA, WV, wl, 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 Gan 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 ofANSIIAHRI 2101240 with Addenda 1 and 2, Performance Rating of Unitary Air -Conditioning & Air -Source Heat Pump Equipment and subject to rating accuracy byAHRI-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. 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. AFRI 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, we make life better— which is listed above, and the Certificate No., which is listed at bottom right. - C)2018Air-Conditioning, Heating, and Refrigeration institute CERTIFICATE No 131745872036674040