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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date- 5;1na I I Permit Number- ! i Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 i Phone: (772) 4624553 Fax: (772) 4624578 Commercial Residential _ PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the and of line P 111 111,110 PRQP©SED INIPRQVI=M NT-LOCA"tit3ll: Address. Legal Description: Property Tax ID #: yoy Lot No. Site Pian Name: Block No. � Project Name: Setbacks Front Back: f Right Side: Left Side: DETAILEDbESCRIPTlON OFW4RK: - C V% r n �b3uak, DElectric ON INFORMATION. to be nerformed unger t is permit -c ec a app y: 13 Gas Tank DGas Piping _ Shutters `one Windows/Doors QPlumbingSprinklers L_=1 Generator l__I Roof Roof pitch Total 5q. Ft of Construction: Sao Ft. of First Flo OSeptilt or: Cost of Construction: $ C� � utilities:Sewer Building Height: OVIfNER/LESSEE: CONTRACT ; Name Name: S�tkeA 1iona Address: 0 Company: City: S ate: jL Address. Le C1 u e - Zip Code: 34 Q�71 Fax: �A __ City: State: Phone No.113--LJ6b - �� 7 a Zip Code: 3U BSc)- Fax -Tio- qUTA 444/6' E -Mail: Phone No. 7)1 J1 - Cos - v Fill in fee simple Title Holder on next page (if different E -Mail: I from the owner listed above) State or County license: u'V C �CoCo t if value of construction is $2500 or more, a RECORDED Notice of Commencement is required. Not Name: Address. City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address.• City: Zip: -ass, Phone: MORTGAGE COMPANY: ._ Not Applicable Name: Address: City: Zip:, BONDING COMPANY: Not Applicable Name: Address: City: ll 11111111 Zip; _ Phone: i.. �",1 :r.ctnllatinn as. mriirated. OWNER/ CONTRACTOR AFFIDVIT00 Application is 1 certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in con#iict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict y rpribrt 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 1 wits, 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, semen 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. g ' r Byrn u'.�iZiG.� `� Signature of Own er% Lessee% Contractor as Agent for owner Signature of Coniractor(License Holder STATE OF FLORIDA - STATI= QF FLQ t COUNTY F COUNTY OF cl ` The for ping instr ment was acknowledged before me The forgoing instr ment was acknowledged before me this day of r 20 12� by this Via- day of c �- .� , 20 -JB by Name of person making statement Name of person making statement Personally Known )S OR Produced identification personally Knownassass _ OR Produced identification tificat Type of identification Type of Iden ion Produced Produced (� 4,ct r (Signature of notary .• (Signature of Notary Publ' . 4, DONNAM NILL 4.: NAM. HILL n MY SION # GG 089038 'COJVJJ§pN# GG 099038 Commission N - �. I Commission N IXPjj�RES j pnf 30,2027 `, • . ' AAri 20, 2029 .F.4s. �'' HondedihnrN • i?i Bondedi'hmNafiaryPnbQcUndenvriters J151oteWPublicUndeerrRM REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 812117 This combination qualifies for a Federal Energy Efficiency tax Credit when placed in service between rating accuracy by AHRI-sponsored, independent, third Feb 17,2009 and Dec 31, 2016. Certificate of Product Ratings AHRI Certified Reference Number: 8900672 Date: 08-22-2018 AHRI Type: RCU-A-CB Series: LX SERIES Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING Outdoor Unit Model Number (Condenser or Single Package) : TC7133621 Indoor Unit Model Number (Evaporator and/or Air Handier): AVC48CX21+TXV Model Status : Active 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 CHAMPION HEATING AND COOLING 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: 17.00 EER (A2) - Single or High Stage (95F) : 14.00 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. 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 srJww.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, Irm M_ 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 bettecy 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.: 131794386983749453