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INFO MU57 BE COMPLETES FOR APPLICATION TO BE Permit Number:
AN APPLICABLE%
a. Building Permit.Application
Planning and Development Services /
Building and Code Regulation Division Residential
Z30o Virginia Avenue, Fort Pierce FL 34982-1578 Commercial
Phone: (772) 462-1553 Fax: (772)
PERMIT TYPE:
PROPOSED
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION'OF WORK:
CONSTRUCTION 1NFORMATIOr
Lot No.__
Block No.
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: (1 Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _Septic Building Height:
OWNER/LESSEE: .CONTRACTOR:
Name V\ V\P J V`/ � Name: Curtis Sammons
Address:�� S ��
City: State:
Zip Code: dgL�LAl Fax:: 1 I
Phone No. rllna "Aqa — 1loq `-t
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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 N o 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 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:
City:
Address:
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
"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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ��, STATE OF FLORIDA �,c
COUNTY OF L_f"6 .GGt-� COUNTY OF t/.i, VCVJ'!�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
day of20by thi�20
this��f�—
� f eu R T15 Sf},M Mop 5-
Name of person making statement. Name of person making statement.
Personally Known �_ OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State of Pforida )
(� i7 2 S�6 20"r r� CHRISTINE B ESN
Commission No. * * MYCOMPASSION#C.
as o� E*WS:ApnT4.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
(Signature of Notary Public- State of Flori CHR15T1NEBE
JSH
My coMMlssK>N�
mission No.Gi% 95a 5 �b * EXPIRES. April
)21 �jF6rcto�o� BrdadTAruBu WN
SUPERVISOR
I PLANS REVIEWREVIEW I VEGETATIONSEREVI,EW E MANGROVE
2111L CA1 t, WA,-n, f�ej 6` OK/1
s�,i,fl2c- P"1 Custom Air Systems Inc. SPOp tAA ' I` d
a/eyk/ 1/tfl'�- 1615 SE Village Green Drive • Port St. Lucie, FL 34952 l A i➢�� GI!) � �
/y Q (772) 335-3232 • Fax( 772) 335-1968 sf91/ oG�
K emProposal and Agreemen
A cIL / , 4 PPJ1'rZ, Phone P1-3 yZ - 76 y� Dateg
Customer Name
Address l` 1-A KC . 1/156 ! "0 107 Job Address
City, State, Zip r S L 3y�S7, Work Phone(s)
We will furnish, install nd service the equipment listed below at the price, terms and conditions outlined on this proposal.
G9 J Equipment Specifications
Make
Model Number(s)
SEER EER AFUE Btuh Cooling Btuh Heating CFM
-lr-s �A�^ C105< 3�X36 (� CK
/. cLRg /'t(e*� eo,r �L la i �o✓3O
It k,C Rn^ tort on t ' ' v
11AlulU ARHP/1�41'6
�r
❑ New Amp disconnect
❑ New Amp electric service
❑ New low voltage 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
[/Charge to manufacturer's specs
V Meet all federal, state & local laws
❑ 01;6e"-{berw)
❑Remove existing equipment from premises
❑ Install energy saving setback thermostat
❑ 1 ew 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
❑1 New vent pipe and cap
IJ Clean work area to customer's satisfaction
❑Y Condensation overflow safety switch
[I Hurricane Fstners ftdoor unit
❑ CFI' -�> �i j�-r II
✓rrrst
", vows QrAC�I�-c S
lY,rvroel�'
X in boxes = Yes
❑ 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
Q/Meet all code requirements
E;J, Com„pI to system start up V� rr
❑ �_ year parts warranty �e�p
❑ �_ year labor warranty
❑_ year compressor warranty
❑ year service a El PAS n'
r�,�inPL �uJr�
Total Investment $
Terms:
fie_ ogli �' f �o P A J S � - `6 /�+^ p!` Se ill CP
Acceptance (Customer) Approval (Company)
Taxes $
Total Amount
Down Payment $
Balance Due $
BY Date By Date