HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: aL
Permit Number:
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
PERMIT APPLICATION FOR:
Commercial
PROPOSED IMPROVEMENT LOCATION:
Address:
Residential
,.C;Yv L PM Lf IGdi Meter Second Electrical Meter
(Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical ' Gas Tank _ Gas Piping _ Shutters Windows/Doors _ Pond
Electric , Plumbing , Sprinklers
Total Sq. Ft of Construction:
Cost of construction: $
OWNER/LESSEE:
Name 1- nI ki l
— Generator
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Address: Dr
City: State:,
Zip Code: Fax:
Phone No.
E-Mail: L I I A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: � )Q11 f
Company w�
Address:
City: J-1-
Zip Code:C
Phone No�
E-Mai116' 1( *Y-
State or County Licem
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
ff value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Roof Pitch
Building Height:
Stater
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE
Name:_
Address:
City:
Zip:
NEER: ` Not Applicable MORTGAGE COMPANY:
Not Applicable
Name:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
Haaress:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:
Zip:
Phone:
—Not Applicable
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorne before commencin or work or recording our Notice of Commencement.
74s�
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA a I -
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this I day of 2021 by
n
Name of person making statement.
Personally Known )( OR Produced Identification
Type of Identification Produced_ �,
Y.
(Signature of Notary Public- St�te of Florida j
Commission No.1-14 ' (Seal)E4%01 Fluiga
anwt� WW HF! 100BxW11l2aza
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
SEA TURTLE MANGROVE
REVIEW REVIEW
• u:ma1 CERTIFIED°
www,ahridirectoty.org
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AHRI Certified Reference Number: 204295307 Date: 07-01-2021
AHRI Type: RCU-A-CB (Split System: Air -Cooled Condensing Unit, Coil with Blower)
Series: GSX16
Outdoor Unit Brand Name : GOOD MAN
Outdoor Unit Model Number (Condenser or Single Package) : GSX16S301A*
Indoor Unit Model Number (Evaporator and/or Air Handier) : ASPT35814A*
Model Status: Active
Region: Southeast and North (AL, AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, Sc. TN, TX, VA, AK, CO, CT, ID, IL,
IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT, VT, WA, WV, Wl, WY, 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 meet the regional efficiency requirement.
The manufacturer of this GOODMAN product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of AHRI 210/240 with Addendum 1, Performance Rating of Unitary Air -Conditioning
& Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing:
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 28000
SEER : 15,00
EER (A2) - Single or High Stage (95F) : 12.20
t"Active" Model Status 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."Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still
Ratings that are accoml anied lay WAS indicate an involunta re rate. The new tinci is she alona with the previous i.e. WAS ratin .
DISCLAIMER
AHRI does not endorse the Product(s) listed 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 all liability for damages of any kind arising out of the use or performance of the product(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 www.ahridirectory.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and
confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated;
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entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual,
smom
personal and confidential reference.
AIR-CONDITIONING, HEATING,
CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE
The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link
and enter the AHRI Certified Reference Number and the date on which the certificate was issued, we make life better,"
which is listed above, and the Certificate No., which is listed at bottom right
02021 Air -Conditioning, Heating, and Refrigeration Institute FCER41CATE NO.: 132696315386060683