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ALL APPLICABLE INFO MUST BE COMPLETED
Date: � 20 ",
Planning and Developmet Services
Building and Code RegulWon qfv1sion
Build*
�%luu virgrnia Avenue, Fort pierce FL 34982
Phone,* (772) 462-J!;53 Faxogoo
-(772) 462-1578
PERMIT APPLICATION FOR: r„ c„fort,
,.+
PR
OPOS'ED
Addressi.a..
I V VG1C((
OVEMI.ENT LOCATION
Legal Description: ;�,,(C-
� r, C,
Property Tax I
D #**
Site Plan Name;
APPLICATION TO BE AWCEPTEp
Permit Number:
Permit Application
Commercial
Residential
fdom- dropbox, click arrow at the end of line
Project Name:
Setbacks Front � flack:
R
DETAILED IESCRiPT1ON--.--..0'F.'W0RK',.•
J✓I ] Y
,
ht Side.
COMMON Left Side,
�(
Lot No.
Block No.
CONSTRUCTfON:INFORMEli
ATI.ON.
tiona .Worktobemw e orm un erthis perm c ec a appy, HVAC
Gas Tank [:]Gas P ing _Shutters
Q Windows/Doors
Electric � Plumbing 1:1Sorfn ins
� r .,,......__ n
Totat 5q. Ft of ConstructionCost of Con�ru�ion: $
OWNE
IIName,
(0000)
a/LESSEE:
uuresso
f!774 Q-4
City
Zip
4;2
R
� ����c�awr [oOf I Raof nitnh
5 of Fdoor:
tilities*12imt
Sewer aseptic Building Height:
CQ;41
TRACTOR:
_ Name: /2. s,—j-r-
Company: LAw,
State: Address: 4 -141-4 S S .✓ ..r, „ _ „ _ ..
Phone No._ 0
E-Mail:
Fill In fee situp{e Title Holder on next page (ff d1fl
from the Owner listed above)
If value of rnnstruchan is $2500 or more, a REGARDED
z 0 cnrlpe 2 =—! Q. r- a
State.0/CC.
ax
Phone No. - . �
EqmMalfi t o�.6--el�3,.---,-
State or COUnty License,,
of Commencement is mquired.
V16P14e--
(.., C. 4^^
SUPPLEMENTAL CONSTRUCTION LIE LAW INFORMATION:
DESIGNER/ENGINEER: _Not App ,cable MORTGAGE COMPANY,•
Name: _
rvame:
Address: A aA......_.
City:
zip: Ph .. one
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Z
�p: Phone:
_ Not Applicable
State: ..City: State:
Zip: Phone:
_ Not Applicable
Not Applicable
Name: —'
Address:
City:
Zi P: Phone:
BONDING COMPANY,
OWNER/ CQNTRACTQR kFFIDVIT; Application s hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced for to the issuance of a permit.
St. Lucie County makes no representation that is gran ng a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners ssouation rules, bylaws or and covenants that may structure. Please consult with your Home Owners Ass. ciation and reviewyour deed'Fvr an restrictions which ma �a phibit such
- y Y Pply,
ire consideration of the granting of this requested per. it, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Bu ding Codes and St. Lucie County Amendments.
The following building permit applications are exempt
accessary structures, swimming pools, fences, wails, s
WARNING TO OWNERSOYour failure to Record..
improvements to your properly. A NoticE
Lucie County and posted on the jobsite N
with lender or an attorney before comme
rom undergoing a full eoncurrency review: room additions,
L ns, screen rooms and accessory uses to another non-residential use
f notice of Commencement may result in paling twice for
i of Commencement must be recorded in the public records of St.
ir
ore the first inspection. If you intend to obtain financing, consult
cing work or record*
ing,your Notice of Commencement.
j
ignature of Owner/ Lessee/Contractor as Agent for"nwl
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed j and subscribed before me of
hysical Presence or Online Notarizatio
this t �"` day of I.... S:.�W:Cwm 2024[ by
Name of person making statement,, -
Personally Known tow�OR Produced Identificatic.
Type of identification
Produced
(signature -of Notary Public- State of Florida �
commissi TAYLOR GAG(5&1)
� �-State f Florida
=. Commission # GG 293167
i'
Janu ry 21 22
EVI EW'.J
COU N R REVIEW
DATE
RECEIVED
DATE
COMP
ev.
LETED
r
VPf�tVISOR
REj/�EW
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF .S r
Sworn to scar affirmed) and subscribed before me of
Physical Presence or Online Notarization
thiskw. "day of 2020 by
Name of person making statement.
Personally Known �OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida -')--
Commission
PLANS
REVIEW
REVIEW
TAYLORGA-___
81)
r Public -State Florida
CoMmission # GG 293167
IVI lsl xi
les
WGROVE
REVIEW
REVIEW
AHRI Certified Reference Number : 202865475
Date: o -1 -2021
AHRI Type : RCU-A-CB (Split System: Air -Cooled Conde; sing Unit, Coil with Blower)
Outdoor Unit Brand Name : RHEEM
Outdoor Unit Model Number (Condenser or Single Pack4ge) : RA1424BJ1
Indoor Unit Model Number (Evaporator and/orAir Hand[ef) : RH1T2417STAN
Reg ion
Region Node
Southeast and North AL, A, DC1
tAfIN, KS, IVIA,ME, MI, MIS,M ,I
Territories)
Eligible for Federal Tax Credit
Model Status :Active
, FL, GA, HI, KY, LA, IVI I IIIS, IBC, OK, SC, TN, TX, VA, AK, Co, CT, ID, ILI
4, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT, VT, WA,1 , WI, VVY, U.S.
Central air conditioners man ufactu d prior to January 1, 2015 are eligible to be installed in all regions
until June 30, 2016. Beginning Jul 1, 2016 central air conditioners can only be installed in region(s) for
which they meet the regional effici ncy requirement.
The manufacturer f this RHEEM product is responsible fir the rating of this system combination.
Rated as follows in accordance with the latest edition of 12 o 2 o with Addendum 1, Perf rr n :e Rating of Unitary Air -Conditioning
Air -Bounce Heat Pump Equipment and subject t rating ccurarc r by AHRI-sponsored,, independent, third park testing;
Cooling Capacity (A2) - Single or High Stage (9517), btuh :122800
SEER : 16.00
EER (A2) -Single or High Stage (95F) : 13.00
t"Active" Model Status are those that an AHRI Certification Prograrl Participant is currently producing AND selling or offering for sale; OR new models that are being
marketed but are not yet being produced."Produrcticn Stopped" Modal Status are those that an AHRI Certification Program Participant is no longer producing BUT is still
selling or offering for sale.
R tin s that are accomDanied bv WAS indicat en inv lunte re-rai e. The new published ratina is shown n lon r ith the revi u i.e.1 1A� .
DISCLAIMER
AHRI does not endorse theproduct(s) fisted 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 a I liability for damages of any kind arising out of the use or performance of the pr du t 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 rww. h rid!rect ry.org.
TERMS AND CONDITIONS
This certificate and its contents are proprietary products of AHRI, :iris certificate skull only b used for individual, personal and
confidential reference purposes. The contents of this Certificate n'� not, in whole or in part, be reproduced; copied; disseminated;
entered into a computer database; or otherwise utilized, in any fori n or manner or by any means, except for the user's individual,
personal and confidential reference. AIR-CONDITIONING,, HEATING,
G,
CERTIFICATE VERIFICATION TI c REFRIGERATION INSTITUTE
The information for the model cited on this certificate can be verifi d t ww. hrid!rectory.or , olio on "Verify Certificate" lint we make life b tt r1'
and enter the AHRI Certified Reference lumber and the date on v i h the certificate was issued,
Reffigerat!nse
CERTIFICATE NO.:
@2021Air-Conditioning,Heating,