HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i�'6 Permit Number:
ouimirig rermi-E jAppicaUUr1
Planning and Development Services
Building and CodeRegulation Division
2300 Virginia Avenue, Fort Pierce FL 34 2
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _
PEKMI I APPLIC:A I ION FUR: To Select from dropbox, click arrow at the end of line
YHUNUSEU IMPROVEMEN I LUCAIION:
Address:
Legal Description,:
Properh, Tax ID - 6 2 ! - 00/6 - OOD Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED DESCKIP I IUN OF WORK;
14—r dt�
�-9d�d'ffi
UCTION INFORMATION:
T-vrork tore-erforr►ied --under t-iis permit - deck aTrt(� apply:
VAC Gas Tank ❑Gas Piping
I� Shutters �ti�'indo� s/Doors
11 Electric E]Plumbing Sprinklers I Generator Roof Roof pitch
Tota Sq. Ft of Construction,: Sq. Ft. of First Floor:
Costof Construction: $ 71- P Utilities aSewerF]Septic Building Height:
OWNER/LESSEE:
Name o 6 V Vr r n
Address: 10//3-
City: State: 7'G
Zio Code: ax:
Phone No. 77,2 SAS ��33
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above}
i CONTRACTOR:
Name:
6U(TI i ,SALO'lcr2
Company:
CUn-FOnt A eEK; l c-
Address:
City: PC) R-T St . L u c i State: r-r—
Zip Code:
n
a+q5).- Fax: 7`T� J35-19 �a
Phone No.
% '1 �L
E-Mail:
C o s t ct
State or County
License: C 4 C C-' S �5
if value of construction is $2500 or more, a RECORDED notice of Commencement is required.
SUPPLEMEN IALCONS i RUC IION LIEN LAW INFURMAI IUN.-
DESIGNER%ENGINEER: _ Not Applicable
MORTGAGE COMPANY- Not Applicable
Name:
Name:
,
Address:
address:
City: State:
Cit•1: State:
Zip: Phone:
i Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not applicable
BONDiNG COMPANY: Not Applicable
Name:
Name: I
Address:
Address:
i
Ctty
City:
Zip: Phone:
up: Phone:
I certify that no %. rk or installation has commenced prior to the issuance of a permit—
St- Lucie Countvmakes-no representation that is granting a permit will authorize the permit holder to build the subject structure
a:hich is in conflict with any applicable Home OO.,iners Association rules, bylaws oranu covenants that may restrict or prohibit such
structure Please consult •-iith your home O<.ners Association and rev�ie,v-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 tie iaork
in accordance �!Ath the approved plans, the Florida Building Codes and St_ Lude County Amendments.
The follo-Aling building permit applications are exempt from undergoing a ill concurrency review- room additions,
accessonr structures, swimming pools, fences, ss�a ts, signs, screen rooms and accessory uses to another nor. -residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your properfiI- A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult Larith lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Contractor/License Holder
Signature of Cn,inerj essee; Coritr CLO,- as Agent i or aia pier ,
STATE OF FLORIDA '
STATE OF FLORIDA
COUNTY OF I
I
COUNTY OF
The forgoing instrument :eras acknowledged befiore me
The forgoing instrument was acknoi;ledged before me
this ( da=l of 20 ! g by
this day of �1�i� 2Q !4b�
I
I
,
(Name of person ackrc. pledging j
(Name of person ackno-w ledging )
t
_
i
(signature of Notary Public- Stag cif Pc! I
(Signature of Notary Public- State o; =Ionic=
Personalty Knodvn OR Produced Identification
` Personally Kpown OR Produced Identification
Type of Identification Produced
Type of ldentification Produced
- - 2q p CHRISMEBl�it�Hinlission
Commission No.: _
MY COMMlSSK3N 3
YPup,
No_
G 032b46 c��� 3
EXPIRE�Apr1
.2�2i
"�tYsmarg r : E+ MYCOL!MM?oY#GGM230
y orrb° za�Cea7lav&sd3�t:
Revised 07 i 1 Si 2G 1-f
?� DTiRES: Apr@ G, 20?1
`o<
REVIE�nIS
FRONT ZONl11lu SUPERVISOR PLANS = VEGi iaT[ON
SEA TURTLE
MANGROVE
COUNTER REVIEW j REViEW I REVIEW REV'IEVU
REA/ IEib'
REVIi=W
DATE
i
`
COIVIPLE T E
INITIALS
MH
0 2MS
l24
knicn
I Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952
I (772) 335-3232 • Fax ( 772) 335-1968
Q Proposal
Customer Name 1 ve t �e/ r
Address loll-3 W6LO JAIL or
P�� 3yy�a
C'it State Zi
p
and Agreement
9
5 �rdo, 62s Yd/O
%S jvG— S2o - /OJI
77z ' S"y,� �i �3 Date -�
Phone
Job Address
Work Phone(s)
y.
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal.
Equipment Specifications
Make Model Number(s)
SEERBtuhBtuh Cooling Btuh Heating CFM
EER
Installation shall include:
.Aras� /-�✓may �
c
❑ New Amp disconnect
❑ Remove existing equipment from premises
❑ New Amp electric service
❑ Install energy saving setback thermostat
❑ New low voltage wiring
❑ New copper wire from to
❑ New weather resistant equipment stand
❑ Make air tight plenum transition
New reinforced equipment pad
❑ new supply diffuser(s)
❑ New vibration isolation pads
❑ New duct run from to
❑ New properly sized refrigerant lines
❑ Noise reducing flexible duct connector
❑ Balance for uniform supply air distribution
❑ New clean, dry ACR copper tubing
❑ Insulate refrigerant suction line(s)
❑ Provide for external combustion air
0 ❑ Install refrigerant drier(s)
❑ New gas piping from to
❑ Evacuate refrigerant system
❑ New vent pipe and cap
❑ Clean work area to customer's satisfaction
❑ Charge to manufacturer's specs
❑ Condensation overflow safety switch
❑ Meet all federal, state & local laws
❑ Hurricane Fasteners for outdoor unit
❑ Option (below) ❑
fZ71 --
Terms:
Acceptance (Customer) Approval (Company)
By Date By
X in boxes = Yes
❑ New condensate drain system
❑ New condensate pump
❑ Install aux. condensate drain pan
❑ New high efficiency air filter
❑ New humidification system
❑ New return air filter grill
❑ Meet all code requirements
❑ Corte system start up
❑ year parts warranty
❑ year labor warranty
❑ _ year compressor warranty
❑ year service agreement
El
yrnl
Total Investment $
Taxes
Total Amount
Down Paymeat $
Balance Due
Date