HomeMy WebLinkAboutCHANGE OUT FORM -WOUTERSALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 X
Phone: (772) 462-1553 Fax: (772) 462-1578 Commerc' Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Ii
Legal Description:. NX +AoUi) —UtJ;T' Ogip -Lo
2P 10)
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Property Tax ID #: C_X-7�- Lot No,,
Site Plan Name:
Block No.
-4-
Project Name:
Setbacks Front Back.- Right Side: nLeft Side:
'DETAILED DESCRIPTION.OF WORK:
6� 95
'CONSTRUCTION INFORMATION,,
d
k7 pp ition m
work t6_b_e ertored -under this permit chec all tha ay
LNHVAC Gas Tank Gas Piping Shutters Li Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sc. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE:
CGNTRACTOR,
N am e x.(AUl C)lf 6,,. UJoul +-er
Name: 6W t
Address: (,O-e- Lis
Company: 4C Sep, V L
i-C
Cty: t A State: 7. _L
�J I
Address: 532- O.'r C!�n PL
Zip Code: CJ J � Fax:
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City: lair-4 State.p
Phone No. q
Zip Code-, 3q 0196 Fax:'Va �>V
E-mail.
Phone No. '72z-- �_7 t —6w
Fill in fee Simple Title Holder on next page if different
0 F, C-e 4- V 0�. r V , �,
E-Mail: i0f, C 'Cck,
from the Owner listed above)
J
State or County License: CAC 1 �14 "I 6a3__
I as U11; %JJ %WVI13LI ULAIU11 13.74JULI Ul 111ulUt d f%r.%-VKUr_U NOXICe OT %.ommencement is requirea,
DESIGNERANGINEE R:
Not Applica
Name:
Address*
city: State,,,
Zip: Phone
le
FEE SIMPLE TITLE HOLDER, Not Applicable
Name:
Address:
City:
Zip: Phone:
0
MORTGAGE COMPANY., Noi't Applicable
Name-,
Address,
City: State:
Zip: Phone,:
BONDING COMPANY: -.Not Applicable
Name:
Address-,
City:
Zip: Phone: ----- -
I
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 Count ,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 Lindergoing 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 Notipe 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
commencinst work or recordinR vour Notice of Commencemerf."-%,--,
Signature of Owner/ Lessee/Contractor as Agent for Owner Signatur4�of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA �N�
COUNTY OF for+ COUNTY OF
The forgoing instrument was acknowledge before me
this day of Ty IV y
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
,(Signature of 06't�ari -Public- State of Florida
F Z-1a
WIN
Mich Daniel
LF 904965
REVM7757'w I -- FRONT I'Z0T41NG
COUNTER REVIEW
DATE
RECEIVED
LCOMPL.ETED
Rev. 8/2/17
The forgoing Instrument was acknowledge4 before me
this _LZ�, day of 26JL &A,) 4,
by
104
Name of person making statement
Personally Known�K_. OR Produced Identification
Type of identification
Produced
_,& ka-Q
(Signature of Notary Pub R6 State of Florida )
Comm sits , , , , , . - 4
Nftry, ptjwomasta of FWda C
Mich le Daniel
My Commission FF 906496
Rupic"Oem
'A
'w SV%0 UPERVISOR PLAN rVv"EGIETATION SEA TURTLE
REVIEW REVIEW REVIEW REVIEW
MANGROVE
REVIEW
T a 1 It ria
AL 1W JIL W a, 1qW A 40
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AHRI Certified Reference Number: 201785375 Date : 05-16-2019 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 Handler): ASPT59C14A*
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, 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 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 t rating accuracy by AHRI-sponsored, independent, third party testing:
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 40000
SEER, 15.00
EEIR (A2) - Single or High Stage (95F) : 12-50
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 accomr)anied bv WAS indicate an involuntary re -rate. The newk blished ratinQis shown aloe with pre
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.ahrldir.pctory.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,
personal and confidential reference. AIR-CONDITIOMING, HEAANING,
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 betterlm
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.
@2019Air-Conditioning, Heating, and Refrigeration lnsti�ute CERTIFICATE NO.: 132024840146506824