HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLLIIC BLE
[INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `'1 Pte-[ 1 <K_ Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
n
Address: 12U 9` rn L I�Ey �n� l�r��ce , 2r�e_ 4 `�Y(e,
Legal Description: L't eti2 - un ,ton -e /J 1 k Lo 464 /(o Arl 19LL LoiJ
Property Tax ID #: $ - pa- - p q 7 - oc>(3 - Lot No.
Site Plan Name: Block No. _
Project Name:
Setbacks Front Back: Right Side: Left Side:
'DETAILED DESCRIIPTION OF WORK -
0
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CONSTRUCTION INFORMATION:
/Aclamonal work to DGas
r orme un er t is permit - c ec a app y:
HVAC Tank ❑Gas Piping_ Shutters Windows/Doors
Electric ® Plumbing Sprinklers E Generator Roof Q Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ r
Utilities: L Sewer ®septic Building Height:
OWNER/LESSEE: CONTRACTOR`
Name ��� Name:5y �0 -. L4 AIr
Address: (o I� �S`�'' S �rce �t Company: u«
City: State: FC- Address 0 S• %i�j r,�c
Zip Code: 3;. YLe �)L_ Fax: City: State:IC�
Phone No. liq Zip Code: St/' 8�_P_ Fax:D2:ig(_S= W0
E -Mail: [ Q Phone No. -7-)a- (-/& - CabCo
Fill in fee simple Title Holder on next Page ( if different E -Mail:
from the Owner listed above) State or County License: OWL,(y Cl
If value of canstruction is $25U0 or more, a RECDRDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAVA INFORMATION:
MANGROVE
REVIEW
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
s
Name:
Address:
Address:
City: State:
Zip; Phone
City; State:
Zip; Phone: -
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY; Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip; Phone:
Zip: Phone:
OWNER/ rf)NTRArrnR ACLIr,.nT.
-- -• --•- .. • • . MiJPNLdL,un 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 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. 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
commencin work or recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
3 -1 7
Signature of Contractor/License Holder
STATE OF FLORIDA'S STATE OF FLORID Q
COUNTY OF COUNTY OF f G�
Theforgoing instr ent was acknowledged before me
this Is day of / 20_B by
Sal u ! . i
Name of perspLo. making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida }
Commission No. "Y., M,HILL
MY COMMISSION # GG 099038
. ;- EXPIRES: April 30, 2021
The forgoing instrument was acknowledged before me
thi 3__ day of 20 2 by
Name of person making statement
Personally Known � OR Produced Identification
Type of Identification
Produced
G" ,
(Signature of Notary Public- State of Florida 1 -
Commission No, M. HILL o,p p"•., N#GG099039
x- MY C;0 MI
EXPIRES: April 30, 2021
--'� • • a;r Thru ri0taf!P Public l}nf� f5
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
SEA TURTLE
REVIEW
MANGROVE
REVIEW
�.:1 CERTIFIED°
www.ahridirectory.org
Certificate of Product
Ratings
AHRI Certified Reference Number: 8456291 Date : 09-24-2018 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) : TC4132421
Indoor Unit Model Number (Evaporator and/or Afr Handler) : AE30BX21+TXV
Region: Southeast and North (AL, AR, DC, DE, FL, GA, Hl, 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, 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 efficfency 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 2101240 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 parry testing:
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 24000
SEER: 16.00
EER (A2) - Single or High Stage (95F) :1,3.()o
i"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.
Rahn s that are acco n anied b WAS indicate an involunta re -rate. The new published ratio is shown alongwith 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 www.ahildirectory.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 users individual,
personal and confidential reference.
CERTIFICATE VERIFICATION AIR-CONDITIONING, HEATING,
The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Vorify Certificate" link & REFRIGERATION INSTITUTE
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 hottom right.
02018Air-Conditioning, Heating, and Refrigeration Institute , CERTIFICATF Nn • 131822693238877194