HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: b -11P -aQ Permit Number:
Building Permit. Application
Planning and Developmenr Services
Building and Code Regulation Division
2,300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMMOVEMENT L00000W
Address:�//y `
Property Tax ID #: v 3��-boa -ooaa " ��� —4 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DES"t
Additional work to be performed under this permit- check all that apply:
Mechanical _Gas Tank _Gas Piping —Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First floor:
Windows/Doors
Roof Pitch
Cost of Construction: $ f �/7 (D utilities: _Sewer _Septic Building Height:
OWNER/LESSEE
Name -1/-
Address• 10,�o,2 %! N -
City: L� / L�ii��� %vG L7State: _
Zip Code: gYzf_ Fax:
Phone No, 7'1'�2 Q?/ '111.2.2.
E -Mail: _
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Curtis ammons
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 CA0051810
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:
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 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, 1 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 COMMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. W YOU INTEND TO OBTAIN FINANCNIG, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFC n
-- ot
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA� STATE OF FLORIDA c
COUNTY OF V.6 oL 6_fi_' COUNTY OF c1ti
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this /B day of L ZIAI , 20,?o by this 1JOday of elan/ , 20Ao by
&hTIS YfMmGnS eURTtS 5M/y?O1S
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 Florida )
Ct& D 5 z5r16 �.• CHMTWE B EN
Commission No. * ; MYCOMASSMIC
sr DMIRES:ApdA
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Flon
ro CHPJST*E B E
JSH mission No. C4 rX a � � � * � MYC�BSSIONf
EXPIRES.Apd
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 21//19
Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952
(772) 35-3232 • Fax 772)335-1968
�lcts ,9�r%r 30
Proposal and Agreement
Customer Name T e s Phone l �- 4 f t� ;2.;L r
Date
Address b�7 gyre e Ed' C
Job Address
City, State, ZipPwI ceCf, jf y�
Work Phone(s)
We will furnish, install and service the equipment listed below at the price, terms and conditions) g�rti�iled on this proposal.
I
C ✓ Equipment Specifications CL@
Make Model Number(s)
SEER EER AFUE Btuh Cooling Btuh Heating CFM
❑ New quip electric service\
❑ New low voliage wiring
❑ New weather resistant equipment stand
❑ New reinforced equipment pad
❑ New vibration isolation pads
❑ New properly sized refrigerant lines
❑ New clean, dry ACR copper tubing
❑ Insulate refrigerant suction line(s)
❑ Install refrigerant drier(s)
❑ Evacuate refrigerant system
O Charge to manufacturer's specs
❑ Meet all federal, state & local laws
❑ Option (below)
u xemove existing equipment from premises
❑ Install energy saving setback thermostat
❑ New copper wire from to
❑ Make air tight plenum transition
❑ new supply diffuser(s)
❑ New duct run from to
❑ Noise reducing flexible duct connector
❑ Balance for uniform supply air distribution
❑ Provide for external combustion air
❑ New gas piping from to
❑ New vent pipe and cap
O Clean work area to customer's satisfaction
❑ Condensation overflow safety switch
❑ Hurricane Fasteners for outdoor unit
I X to boxes =
❑ 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
❑ Complete system start up
❑ year parts warranty
❑ year labor warranty
❑ year compressor warranty
❑ year service agreement
❑ D 11l j Total Investment $
Taxes $
Total Amount
Down Payment $
Balance Due
Terms:
Acceptance (Customer) Approval
By Date By _ Date