HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'I I 16, 11 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the and of line
:PROPOSE..Im WENT
Address:
Legal Description:
Property Tax ID #: Soz - on (),- (Xv- 4
Site Plan Name:
Project Name:
Setbacks Front Back. _ Right Side: Left Side:
DESCRIPTIOkI ®l'
AC, cwtq
n SCC it-;
3RK;"
Lot No. 4�()
Block No.
�CONSTRUCTION IN -ORM-A-T-ION
rM
Additi6iialworKTODe erro R unger this p-eFmtt –check all mat apply:
HVAC~~
0
Gas Tank LJGas Piping Shutters Windows/Doors EJ
13 Electric El Plumbing O5prinklers Generator D—Roof Roof pitch
Total Sq. Ft of Construction: S. Ft, of First Floor.
Cost of Construction: $i fUf
lities:nSewer 13S.eptic Building Height:
9S�EE
owKE
,CONTRA cr
Name aft11C1ktA
Name: lr0- hi
Address: 1
City: State
Zip Code:C Fax:
Company:ri�lilw%_10 U L
Address:
city: State
Phone No. 1- 10')
Zip Code: S4�c4�2, Fa :21, AA45
Phone No. 01P
E -Mail: w� ED, AA(u -FU m 4V a) �6+ 1,
State or County License:
E -Mail" tr
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
If value of construction is R500 or more, a RECOIRUELI notice or Lornmencarnerm is requireu.
,SUPPLEMENTAL CONSTRucnONIJEN-LAW INFORMATION.
DESIGNERIENGINEER: _ Not Applicable MORTGAGE COMPANY• Not Applicable
Name: Name:
Address: Address:
City State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name. dame: —
Address: Address:
City: City:
Zip: Phone: Zip:. Phone:
OWN ERI 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.
5t. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
rurlesvAth �ylersorvycovenants that
prohibit such
structure. Please consultw with applicable
owners owners
and review your deed fory restrictions vih ch may
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 our Notice o#Commencement
Signature of Owner) Lessee/Contractor as Agent for owner
STATE OF FLORIDA
COUNTY OF
The forgoing instru e t was acknowledged before me
this i day of Zi] A& by
• !&K.
Name of person making statement
Personally Known ')S OR Produced Identification
Type of Identification
Produced
(Signature of Notary p NAM. }TILL
Commission N `CI) N#GG 099038
EXPIRES. prii 3D, 2029
Bonded Thm NuiaryPublic Undenvrlists
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
I COMPLETED
Rev. 8/2/17
6
Signature of Contractor/License Holder
STATE OF ELOi4
COUNTY OF 3w C��
The forgoing instrum nt as acknowledged before me
this ,� - day of Ll 2o–L by
Aame of person making statement
Personally Known. -;4 OR Produced Identification
Type of Identification
Produced
—C)'L'- - - q -y\
{Signature of Notary Pub
Commission N ^ V
PLANS VEGETATION
REVIEW I REVIEW
-00NNAM ILL
MY SIQN # GC 099038
April 30, 2029
Band�li�ru Notary public Unde�yrltara
SEA TURTLE l MANGROVE
REVIEW I REVIEW
This combination qualifies for a Federal Energy Efficiency tax Credit when
placed in service between Feb 17,2009 and Dec 31, 2010.
Certificate of Product Ratings
AHRI Certified Reference Number : 8901427 Date: 07-10-2018 Model Status: Active
AHRI Type: RCU-A-CB
Series: LX SERIES
Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING
Outdoor Unit Model Number (Condenser or Single Package) : TC7134221
Indoor Unit Model Number (Evaporator and/or Air Handler) : AF48CX21+TXV
Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, 1D, 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 CHAMPION HEATING AND COOLING product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSIIAHRI 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 : 42000
SEER: 17.00
EER (A2) - Single or High Stage (95F) : 14.25
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.
Ratin s that are arcom nied bv WAS indicate an involuntary re -rate. The new Dublished ratin is shown alona with the orevious i.. WAS) ratin .
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.ahridirectery.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personaland
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 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.
92018Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131757082986134428