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HomeMy WebLinkAboutDrMaltmanPermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: it - f- la 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 TYPE: Name: 'ezn.(- _V�e7 Company: Address: %A!A ® (JC City: '�� _C1 k0I? State: L_ Address: 142,(S cy.1S Zip Code: 2AqS-7 Fax: ' t�E. f � Zip Code: AR q S Fax: Phone No E-Mail:M'm�' 6hoG r (f�i� Fill in fee simple Title Holder on next page ( if different P"'N JJ.. 1 e.Al i /� < r�uuc��. i mow✓ -�-; v . 1a% r v V? Property Tax ID #:.4S® 1-06 C)© '�{ "` ��� -7- Lot No. Site Plan Name: Block No. Project Name: Additional work to be performed under this permit -check all that apply: Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ L132-6 Utilities: —Sewer —Septic Building Height: Name ("ico eA 4VWa k -me.. -n Name: 'ezn.(- _V�e7 Company: Address: %A!A ® (JC City: '�� _C1 k0I? State: L_ Address: 142,(S cy.1S Zip Code: 2AqS-7 Fax: City: ctf.y YC Phone No. -777- IN - 7U10 Zip Code: AR q S Fax: Phone No E-Mail:M'm�' 6hoG r (f�i� Fill in fee simple Title Holder on next page ( if different E -Mail T(' u,A c -C CG �t 1 from the Owner listed above) State or County License 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. State: s i DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: �L' Not Applicable Name: Name: Address: Address: City: State: City. State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Applicable Name: _Not 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 thepermit 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 IMP OYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEME MUST BE RECORDED AND POST ON T JOB SITE BEFORE THE FIRST INSPECTION. IF INTEND O TAIN FINANCING, CONSULT WIT YO R L ER OR ATTORNEY BEFORE RECORDING YOUR NOTICE O OM ENCEMENT." A'Al �� / A/ d Sig ature Ow, see/Contractor as Agent for Owner SigWature Cont r ' nse Holder STA OF FLORIDA ST FLOR A COUNTY OF �'T ly f / COUNTY OF < -- L LZ r if The forgoing instrument was accnowledged before me The forgoing instrument wal cknowledged before me this � day of 202�by I this � day of 2 0_2_a y r PZ Q1— d2e t-- e Z r e z a it- Name of person making sfatement. Name of person making Aatemeht. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identifi ation t ,� N Produced�� � � L /cen5� Type of I ification h Producer T ( ture of Notary Pu lic- State of Florida ) ( ure of Notary ub ic- State of Florida) Commission No. AA#V NC45E#&)Oic Sta10 of Fi rift Mata ommission No. WpAP­�N� otary P aq at p��Leo -� 'MyCommaaion eo Mate GG 2S2204 Y Cammisaion GG 252ZM �-006 w Oft 2022 REVIEWS F R 0 N PLANSVEGETATION SEA A COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED i ev. AHRI Certified Reference Number: 203459940 Date : 03-31-2020 Model Status: Active AHRI Type: RCU-A-CB Outdoor Unit Brand Name: AMERICAN STANDARD Outdoor Unit Model Number (Condenser or Single Package) : 4A7A4024L1 Indoor Unit Brand Name: AMERICAN STANDARD Indoor Unit Model Number (Evaporator and/or Air Handler) : TMM5B0A24M21 SAA 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) ?"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. Ratings that are accompanied by WAS indicate an involuntary re -rate. The new published rating is shown along with the Previous (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 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, AM 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 `Verity Certificate' link w, 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. `"' ©2020Air-Condition ing, Heating, and Refrigeration Institute 1 CERTIFICATE NO.. 132301767690264199