HomeMy WebLinkAboutBuilding Permit Application All APPLICASL NFO UST RE COMPLETED FOR APPLICATION TO 8f ACCEPTED
Dater Permit Number: �' �,
40
•
BUllding Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue Fort Pierce FL 34982
Phone:(772)462-sSS3 Fax: (772)462-1578 Commercial Residential
PERMIT AP PLICATION FOR; _Tw� a
,.PROPOSED tNR l�1l.�ME14T
Address: C
Legal Description:
Property"fax Ip#:_� 1 �V(�� �i1�� Lot No.
Site Plan Name: Block No.
Project Name: •►JfZ
elf
Setbacks Front Back: Ight Side: Left Side:
[K-A
'+. we(
w A
th
Lie
CONS"CEtUCTIO�l-".I. t4�OR,.M ►3 I'JN':- ,.1y
> > na work o• a pe Orme un er s perms -ces a a aAA y
echanical _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:
OWNERLESSEE:
CONT
Name Name: l71
Addr Company;
City: State• Add
Zip Code: Fax•. City: State:
Phone No Zip Code: Fax:
E-mail; Phone No. _..
Fill in fee simple Title Holder on next page(if different -
from the Owner i1sted above) State a County License: bfilf-i0e:315
1f value of construction is 2500 or more,a RECORDED Notice of COMMencell eat iS Pegpir@d,
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 make no repr entation that Is granting a permit will authorize the permit holder to build the subject structure
which Is In conflict witt 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 jobs ite
before the fir ctlon. If you Intend to obtain financing,consult with lender or an attorney before
com n w+ r r recording our Notice of Commencement.
S re of Owner/Agent/Lessee 5 ontractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF , _LrtQ COUNTY OF + Wtt
The f r oing Instru en was acknowledged before me The fp ppuling instrqm, 'en't was acknowled�ac�before me
this day of , 20D by this 13 day of i by
S CU&I.
(Name of person acknowledging) (Name of person acknowledging)
.0170 AL
( ig ature of Notary Publ - tate of Florida) ftnature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Produced Type of Identificatio Produced,�y
tt Notary PUbJ1c8tmtedF9d"=M ion No.vV �t�� I Nat�rryPu6tic9trtad
commission Na. i �.. )chdrtine Holvind 4
. Christine Hoiktnd myChian dti�ale 4
My 1 RMA ion 00 9 �7b4 Exalrrs OIrY�t$OTS 4
INNN1�
REVIEWS FRONT ZONING SUPERVIS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-Rev.772014-00
sual CERTIFIED 'Ek
iii
Certificate of Product Ratings
AHRI Certified Reference Number 202936815 Date:07-15-2020 Model Status:Active
AHRI Type,SP-A
Outdoor Unit Brand Name;AMERISTAR
Outdoor Unit Model Number (Condenser or Single Package):4TCA4042AI
Region; All(AK,AL,AR,AZ CA,CO,CT,DO,DE,FL,GA,lit,10,1.1.,IA,IN,KS,KY,LA,MA,MD,ME,MI,MN,MO,MS,
MT,NC,NO,NE,NK NJ,NM,NV,NY,OH.OK,OR,PA.RI,SC,SD,TNI,TX,UT,VA,VT,WA,WV,Wl,VVY,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 most the regional efficiency requirement
The manufacturer of this AMERISTAR product Is responsible for the rating of this system combination.
Rated as follows In stoordarice with the latest edition of ANSIIAHRI 21040 whb Addenda I and 2,Performance Ratillo of Unitary
Air-CondItIontrig&Alt-Source Most Pump Equipment and subject to rating accuracy by AHRI-sponiored.Inde;pendent,third piny tasilling-
Cooling Capacity(A2)-SIngle or High Stage(95F),btuh:41 ON
SEER,14,00
EER(A2) Single or High Stage(95F) :11.50
tActive"Model Status are those that an AHRI Certification program Participant is currently producing AND selling or offering for sale,OR now models that are being
marketed but are not yet being producad,'Productlon Stopped'Model Status are those that an AHRI conitication Program Participant is no longer producing BUT is still
!iioto
am tar sale. led by WA!�,InOcato in 10volUntery re-rate.The putillshad rafing ls,j�pjo itiong vAth the reviggi(Le.WAS)rAting.
I)ISOLAIMCR
AMR[does net endorse the product(s)listed an this Certificate and makes no repreguntatiorut,warranties or guarantees as to,and assume&no responsibility for,
the praduct(s)listed an this Certificate.AHRI expressly alocialms all liability for damages of any hind arising cut of the use or performance of the product(s),or the
unauthorized alteration of data listed on this Certificate.CartIflett ratings are valld only for models and configurations listed In the
directory st WWW.4hrIdIr*oIAry.0Fg.
TERMS AND CONDITIONS
This ceruflots and its contents are proprietary products of AMR[.This Certificate shall only be used for individual,personal and Also
*"fidentlal reference purposes.The contents of this Certificate may not,In whole or In part,be reproduced;coplod;disseminated;
entered into a computer database;OF otharW150 utilized,in any form or manner or by any means,except for the user's Individual,
personal and oonlildvittlal reference. AIR-CONDITIONING,MATING,
CERTIVICATIF VERIFICATION &ItErRiamnoN iNsntvri:
The InformfitJon for the model citedon this cartItIcate can be verified at WWWahrldirectory.org,click an'Verity Certificate-link
and enter the AHRI CartIfted Reference Number and the date on which the certificate was Issued, we tuak.I&bruer-
which Is listed above,and the Certificate No.,which Is listed at bottom right.
02020AIr-Condltloning,Heating,and Refrigeration Institute IFICATE NO.: 13239280287002219