HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �
Permit Number:
o
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 —
PERMITTYPE: �604VI �r—
I'I_OPOSED IMPROVEMENT LOCATION:
Address: —
Property Tax ID #: .�
Site Plan Name: _ Al U I
Project Name:
DETAILED DESCRIPTION OF WORK:
. C450 ` ()
Resldenual
Lot No.�
Block No.
CONSTRUCTION INFORMATION:
I
Additi al work to be performed under this permit -check ail that apply:
Z—MePiping — Gas Tank Gas Pi
— P g --Shutters Windows/Doors
—Electric _plumbing —Sprinklers Generator
— Roof _.�.� pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ ' 5� Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name al�� 1JGGi rJ1.¢.e!
Name: ✓ �(GG
Address q S
City: C, Company:
State:- Addres
Zip Code: 3 q �, Fax: City: Stater
E-Mail:
Phone No. i �04���' f � j
Zip Code: Fax:
Phone No%f;
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) ,
State or County License s Q
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
IN
Name:
Address:
City:
Zip: Phone
— Not Applicab
State:
FEE SIMPLE TITLE HOLDER: Nat Applicable
Name:
Address;
City:
Zip: Phone:
MORTGAGE COMPANY:
NotAn licabl
Name:
Address:
City: State:
Zip: � Phone:
BONDING COMPANY.
Name:_
Address:
City:_
—Not Applicable
f Lip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated -
issuance
certify that no work or installation has commenced prior to the issuance 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 JOB BEFORE THE PIRST INSPECTION. IF YO
WITH YOUR LENDERAffl INTEND TOO IN NANCI G, CONSULT
A AORNEY ORE RECORDING YOUR NOT F CO E AIN FINT."
Signature of Owner/ Lessee/Copt as Agent fo Owner
STAVE OF FLORIDA
COUNTY OF
The for oing instrum was acknowledged before me
thisMa of � C1 . 26 by
Name of person making statement.
Personally Known A. OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pu ic- State of Florida }
Commission No.
r."RIS WOOflBERRY .�
REVIEWS �2ut
ERVISOR
T REVIEW
DATE
R£CEP
DATE
COMP
1
Signature ofContractor/License H
STATE OF FLORIDA 06
COUNTY OF
The f going instrument. Was acknowledged efore me
this day of i �f 20-a by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of No ry Public- Sta Florida )
Commission No.
S WOODBERRY
REVI S I=,I °'9 MANGROVE
REVIEW
This combination qualifies for a Federal Energy Efficiency tax Credit when
CERTIFIED *0 placed in service between Feb 17,2009 and Dec 31, 2016.
r,
Certificate of Product Ratings
AHRI Certified Reference Number: 10259403 Date: 07-02-2019
AHRI Type: RCU-A-CB
Series : ELITE EL16XC SERIES
Outdoor Unit Brand Name: LENNOX
Outdoor Unit Model Number (Condenser or Single Package) : EL16XC1-024-230A**
Indoor Unit Model Number (Evaporator andlor Air Handler) : CBA27UHE-024-230*+TDR
Model Status: Active
Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, Hl, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI,
, MN, MO, MS,
MT, NC, Nil,, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WAWV, 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 LENNOX 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 (959, btuh : 24000
SEER: 16,00
EER (A2) - Single or High Stage (95F) : 13.00
"Active" Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sate; OR new models that are being
marketed but are not yet being Produced." Production Stopped" Modek Status are those that an AHR! Certification Program Participant is no longer producing BUT is still
selling or offering for sale.
Ratinnc+h�+nra o�.............._��.. ,.,.., -
DISCLAIMER
qua ki.e. vvtAz>i raun .
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 products) 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 Ifsted in the
directory at www.ahridfrectory.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.
CERTIFICATE VERIFICATION AIR-CONDITIONING, HEATING,
The information for the model cited on this certificate can be verified at www.ahrid irectory.org, click on 'Verify Certificate' link & REFRIGERATION INSTITUIFE
and enter the AHRI Certified Reference Number and the date on which the certificate was issued, we makc life bLtter° which is listed above, and the Certificate No., which is listed at bottom right.
19Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132065457383149386