HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: D Permit Number:
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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; / �---
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Address: O
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Property Tax lD#: y 0l_� 131 C)u Qn c d. o g Lot No.
Site Plan Name: Block No.
Project Name:
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Addit nal 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 n5truction:$ J� Utilities: —Sewer _Septic Building Height:
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ame Name:
Addre s: - Company:
City: ` r ' State; ddre rz 4
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Zip Code: Fax: City: t�.0 S ate: (�..
Phone No, Zip Code; Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page,( If different E-Mafgl�(
from'the Owner listed above) state o County License_
If value of construction Is$Z500 or more,a RECORDED Notice of Commencement Is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement 15 required.
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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.L cle 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,
accessary structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
"WARNE1IC 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. IF YOU INTEND TO 013TAiN FINANCING, CONSULT
WITH YOUR R AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF NCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA, STATE OF FLORID
COUNTY OF COUNTY OF t v.)� Lu Cl t,,
The or oing Instrument was-acknowledged before me The forgoing instru nt yvas acknowledged before me
this day of 26 by this�day of CAI 200�9)by
e -fiClennia C,uesic&
Name of person making statement. Name of person making statement,
Personally Known ��OR Produced Identification Personally Known h OR Produced Identification
Type of Identification Type of Identification
Produced Produced
1
(KITMFUre of Notary Public-sti re of Notary Public-State o
NoteiY Pun►fe State of FI L,_
ry Put�lt:StateIlp"�ia� C ratneHoiiand +�, �5' -�04ri��Ifstine HoliendCommission No. a Commiaaion a0 3287 Co mission No ,, omminfan(ii[inexpires ar�y2oZ3re 04I220423
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
PATE
RECEIVED
DATE
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certificate of Product Ratings
AHRI Certified Reference Number:202936815 Date:06-26-2020 Model Status-fictive
AHRI Type:SP-A
Outdoor Unit Brand Name:AMERISTAR
Outdoor Unit Model Number (Condenser or Single Package);4TCA4042A1
Region: All(AK,AL,AR,AZ,CA,CO,CT,DC,DE,FL,GA,HI,ID,It.,IA,IN,KS,KY,LA,MA,MD,ME,MI,MN,MO,MS,
MT,NC,ND,NE,NH,NJ,NM,NV,NY,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VA,VT,WA,WV,WI,WY,U.S.
Terrltorlss)
Region Note; Central air conditioners manufactured prior to January 1,2015 are eligible to be.Installed In all raglans
until June 30,2016.Beginning July 1,2010 central air conditioners can only be Installed In region(%)for
which they meet the regional efficiency requirement.
The manufacturer of this AMERISTAR product Is responsible for the rating of this system combination.
Rated as follows In adcor lance'wlth the latest edition of ANSI/AHRI-2101240 with Addetide 1 and 2,Pbr(armoride f dtjng of'VhIIaty
Air-Conditlontrig$Air-Sauna Waat'Pump Iquipment and subject to rating accurlecy by'AHRl-sponleored:Inds ride(t,thlio party tggtY�p:
Cooling Copikolty(A2)-Single or High Stage(95F),btuh;41000
BEER.,U1,00 '
PER(A2)-8lftgie or High Stage(05F) :11.50
t"Active'Model Statue 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.•Productlon Stopped"Model Status are those that an AHRI Certification Program Participant is no longer producing BUT Is suit
ell n o ofrerin for pate.
DISCLAIMER
AHRI does not endorse the product(a)listed on this Certificate and makes no repre¢entatlons,warrantles or guarantees as to,and epeumes no respons)blllty for,
the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arlslno out of the use or performance of the produst(s),or the
unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed In the
di-Mry at www.Ahrldiracto►y,org.
T1fncer AND CONDITIONO
Thin Certificate and Ile aontsnta are proprietary produCtb of AHRI.This certificate shall only be used for Individual,personal end
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,
personal and confidential reference. AIR-CONDITIONING,HFATINa,
CERTIFICATE VERIFICATION A REFRieiRATION INSTtttITR
The Information for the model cited on this certidoate Olin be verified at www,ahvidireotery.org,click on'Verlfy CertlNoate"link we make fit(-hect.•ra
and enter the AHRI certified Reference Number and the data an which the certificate was Issued,
which In listed above,and the certificate NO.,Whigh Is listed at bottom right, � �--
C2020AIr-Condltloning,Heating,and Refrigeration Institute �WrIFICATE NO.: 1323764614630821719