HomeMy WebLinkAboutBuilding Permit ApplicationALL ,APPLICABLE INFO MUST BE COMPLETED FOR APP LI A►TION To BE ACCEPTED
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Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, `ort Fierce FL 34982
Phone: (772) 462-1.558 Fax. 772 462-1578 or° mer
l Residential
PERMIT APPLICATION FOR: To Select from ro boy click arrow at the end of lino
'PROPOSED IMPROVEMENT
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Lot No
Site Plan Name:
Block No.
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Project Name: LO Ck 4/4
Setbacks Front Back. Right Side:
Left Side:
DETAILED DESCRI'?T!,ION OF WORK:
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Addition-aT to be ertormed under this perms -- check
11 PS11 ISA Cas Tank Cas Piping
apply:
„n, Shutters windows/Doors
Electric Plumbing Sprinklers
Generator Roof Roof pitch
Total Sq. Ft of Construction.
S . Ft. of First Floors
Cost of Construction. �` utilities:
Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACT R.
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Name , '.� - ..
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Name. ` t
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Company: Se_rV1C.-'e"
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Fill in fee simple Tile Molder on next page ( if different
F-I'rr'lail: 4 �� ` �� _ ` , .� ��� `� �CO. In
from the owner listed above)
State or County License: I %i 116 a3
oticro f Commencement
onstruction is $2500 or more, a RECORDED Notice ommancement is required,
ifvalue o construction quireM,
$1UPPLEMENTALCC
DESIGNERANGINEER:
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NSTRI. CTION UEL.�'4i, 't).,.AW
Not Applicable
Name:
Address:
City: State:
Zip: Phone..
FEESIMPLE TITLE HOLDER.0
NotApplicabie
Name:
Address:
City °_
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
city: State:
Zip: Phoned
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 work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting aP ermit 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
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
commenciniz w
DA or recording yo r Notice of Commencemelff.
S I ignature of Owner/ Lessee/Contractor as Agent for Owner I Signatur4/of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF f or+ COUNTY OF t
The forgoing instr4ment was acknowledged before me
this day of 20 by
I
Name of person making statement
Personally Known- X OR Produced Identification
Type of Identification
Produced
,(Signature of ff6tary Public- State of Florida
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Mcholle DoWel
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.jojo,f F 906496
RE\/TWr "FRONT IO'N
'ZING
I COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing instrpment was Acknowledged before me
this day of ry n_, 20 l by
A.
i ) av
Name of person making statement
Personally Known X _ OR Produced Identification
Type of Identification
Produced
(Signature of Notary PubgState of Florida
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Comm I N0!.1rppw%,1e6tsftofFkwk1a al)
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Michrjle'Danlel
My Commission FF 906496
SUPERVISOR I PLANS'T_ VE-GETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
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AHRI Certified Reference Number: 201785374 Date: 09-06-2018 Model Status: Active
AHRI Type: RCU-A-CB
Series: GSX16
Outdoor Unit Brand Name: GOODMAN
Outdoor Unit Model Number (Condenser or Single Package): GSX16S421 A*
Indoor Unit Model Number (Evaporator and/or Air Handier): ASPT49Dl4A*
Region Southeast and North (AL, AR, DC, DE, FL, GA, H1, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, AK, CO, CT, ID, IL,
lA, Ill, KS, MA, ME, W, MN, M®, MT, ND, NE, NH, NJ, NY, OH, OR, PA, Rl, SD, UT, VT, WA, WN1, Wl, WY, U.S.
Territodes)
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 GOODMAN 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 i 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 : 41000
SEER: 16.00
EER (A2) - Single or High Stage (95F) : 13.00
t"Active" Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale; ®R 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.
Ratangs paf-are_APQQmwpied,ty indicate an involuntare-rate. The new QWblished LiaQ"--.shown elan gwith the r)revLQ—US—C1.e WAS )Egtin g.—
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DISCLAIMER
AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or gLoarantees as to, and assumes no vesponsibillity for,
the product(s) listed on this Certificate. AHRI expressly disclaims aHu liability for darriages of any kind arising out of the use or performance of the product(s), or the
unauthovized alteration of data listed on this Certificate. Certified ratings are valid only for models and configuvations listed in the
directovy at www.ahr1d'rectoq,,,.oq,,'.
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, WIN
personal and confidential reference. AIR-CONDITIONING, HEATING,
CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE
The information for the model cited on this certificate can be verified at wwwahy';dirpc-'i,,ory.org, click on "Verify Certlif leate" linkwe make life betteem
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. 131807326082695170
@2018Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: