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HomeMy WebLinkAboutBuilding Permit Application[All 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 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: G PROPOSED INPROVEMENT LOCATION: Address: � Ao? Legal Description: Property Tax ID #: S `t I — S C)+ (p t q (0 0 0 a — 1 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: to e CONSTRUCTION INFORMATION: it na w)r to e pe orme un er this y:i Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors Electric —Plumbing _Sprinklers _Generator Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ ��� , Utilities: —Sewer _Septic Building Height: OWN ER/LESSEE: CONTRACTOR: Nam Name: LJ Ob Addre Company: City: State: Add re&s: r Q Zip Code: Fax: City: Zip Code: State: Fax: Phone No. E-Mail: Phone No. Fill in fee simple Title Holder on next page if different E-Mail tC• from the Owner listed above) State or County License: SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: 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 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 commencing work ding your Notice of Commencement. ' Signature of Owner/ Agent/ Lessee Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF Soa+n-V L Ce STATE OF FLORIDA ' �c COUNTY O F Sc.� % The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this:�)6 day of 20 1 by this day of OL'� ���+' , 20 i`j by V\-c1\Qnd D)Y(S�v\e_ �Ao \\ayid (Name of person acknowledging } (Name of person acknowledging } (Sign"ature of Notary Public- State of Florida } (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No. 3abiOLA ,,, Se tary Public State of Flori mission No.&1313a�q-l0'4 o�a�y Public State of Florida tom Christine Holland �a►II',L 14 Christine Holland ... My Commission GG 327 M� .. My Commission GG 326704 �i x fires 04/22/2023 xp�re 04 2/2023 REVIEWS FRONT NS VEGETATION COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. I AHRI Certified Reference Number: 202349756 Date: 10-28-2019 Model Status : Active AHRI Type: RCU-A-CB Series: GSX14 Outdoor Unit Brand Name: GOODMAN Outdoor Unit Model Number (Condenser or Single Package) : GSX140361 K* Indoor Unit Model Number (Evaporator and/or Air Handier): ASPT35B14A* 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. Th Ra Air Cc SE EE 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. Ratinas that are accompanied by WAS indicate an involuntary re -rate. The new published ratino is shown alono with the Drevious (i.e. WAS) ratina. 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.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL 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; AM 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-CONDITIONING, HEATING, 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 better'" 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 Institute ERTFIATE NO.: 1321674542281U$4