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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: TAN iw Avay Permit Number:
s
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
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATIONS "
Address: Alin 9%rle-
Property Tax ID #: 3yl6 - 66y- G /�%'G�rTj -� Lot No.
Site Plan Name:
Project Name:
Block No.
AdZechanical
work to be performed under this permit —check all that apply:
_ Gas Tank _ Gas Piping Shutters
_Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 7`f . 7 5
OWNERAESSEE:
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _Septic Building Height:
Name o ode- S
Address: -%%0 6p /%Ct! /r-
City= �m� r .�'!/�i e State: F•L
Zip Code:.,, Z �Z<J��ZJ Fax:
Phone No.. 4e
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
fNTRA�€{3R: '
Name: Curtis Sammons
Company: Custom Air Systems, Inc.
Address: 1615 SE Village Green Drive
City_ Port Saint Lucie State: FL
Zip Code: 34952 Fax: 772-335-1968
Phone No 772-335-3232
E-Mail custairsys@aol.com
State or County License CAC051810
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 LAIN INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
"WARN LING 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 SITE BEFORE THE FIRST INSPECTION. F YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORD■IIG YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA (f p STATE OF FLORIDA
COUNTY OF Ali— oLU.G(� " COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _yday of 7WIV 20 d o by this /-/ day of T�AJ 20 ao by
Name of person making statement. Name of person making statement.
Personally Known � OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of fforida
Commission No.46t 052546
r
4P. —
t
REVIEWS
FRONT
I
ZONING
COUNTER
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known i(' OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of F
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mission No. ®sa 5�6 *V�, M�'calsassloN:
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
Custom Air Systems Inc.
1615 SE Village Green Drive • Part St. Lucie, FL 34952
(772) 335-3232 • Fax( 772) 335-1%8
Proposal and Agreement
Customer Name f' � Phone .� 091V- P-- Date_1*
J r w
Address 1- T� Job Address
City, State, Zip - Fork Phone(s)
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal.
Equipment Specifications
Make � Q PT —IT Model Number(s) A .� � � _
SEER __ EER AFUE _ _ Btuh Cooling. Btuh Heating CFM
Instd•lNation ghalf include:
,'1 i l 11 s
,7 New Amp disconnect
❑ Remove existing equipment from premises
i:..; New Amp electric service
C+. 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 diffusers)
New vibration isolation pads
❑New duct run from to
.'- New property sized refrigerant lines
❑ Noise reducing flexible duct connector
* New clean, dry ACR copper tubing
❑ Balance for uniform supply air distribution
Insulate refrigerant suction linets)
❑ Provide for external combustion air
Install refrigerant drier(s)
❑ New gas piping from to
Evacuate refrigerant system
C. New vent pipe and cap
Charge to manufacturer's specs
❑ Clean work area to customer's satisfaction
Meet all federal, state & local laws
❑ Condensation overflow safety switch
N'Option (below)
Ci Hurricane Fasteners for outdoor unit
0 —...
Terms:_._..
Acceptar)
By I Date
By
X in boxes
❑ New condensate drain system
New condensate pump
❑ Install aux. condensate drain pan
10 New high efficiency air filter
❑ New humidification system
• New return air filter grill
El Meet all code requirements
Co bete system start up
❑ I c., year parts warranty
❑ 1_A_ year labor warranty
❑ J-b— year compressor warranty
❑ -�-- year service agreement
—
Yes
Total Investment S
Taxes_ —
Total Amount S.
Down Paymeat
Balance Due
Date 4�