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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED F Date: F j Build! Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 TO BE ACCEPTED Permit Number: Permit Application Residential �_ PERMIT APPLICATION FOR: To Select dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATIE3N: Address: _5 � Legal Description: _ `f ,(_ n �-`c C C ,- `- Property Tax ID #: { - Lot No. Site Plan Name: Block No. G Project Name: Setbacks Front Back. Riglit Side: Left Side: DETAILED DESCRIPTION OF WORK: 3, S C_ /C 6, c !^l L y s , , 14) s a iC --- CONSTRUCTtON INFORMATi.ON: itiona wor to e e orm un er his permi checK all thatapp y: 6HVAC Gas Tank JElearic ❑Gas FiSprint P ng Shutters ED windows/Doors Plumbing I rs Generator C] Roof Roof pitch Total Sq. Ft of Construction: /, S . Ft. of First Floor: Cost of Construction: $ �` ®� tilities: Sewer 0-Septic Building Height: OWNER%LESSEE: CC?NTRAGTUR:. . Name L,' t Lf Z. - Name: c�,f Add re s: 2 — Company: _ City: -C State: _ '- Address: � 4 _ r. ; n-. C, o e c-% - Zip Co a:1_� j Fax: City: - State:E]�_ Phone No. 6 L) S d-o r - Zip Cade: '2 =-/ Fax: E-Maim Phone No. -_') '7..) / -• ! E-Mail: &c)c, L-, :- Fill in fee simple Title Holder on next page (N differ I it from the Owner lined above) Is- — State or County License: c_js,� -- ---.-c v1 wiraaru4Zlan 1s 443uu or more, a Ktwnutu nggce _oT Lommencement is required. SUPPLEMENTAL CONSTRUCTION LIE ` LAW INFORMATION: DESIGNER/ENGINEER: — Not Appl Name: Address: City: State: Zip: Phone ble MORTGAGE COMPANY: _ Not Applicable Name: _ Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Appl Name: ble BONDING COMPANY: Not Applicable Name: — Address: City: Address: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application ereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced pi to the issuance of a permit. St. Lucie County makes no representation that is grant n which is in conflict with any applicable Home Owners j s a permit will authorize the permit holder to build the subject structure ciation rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Ass i tion and review your deed for any restrictions which may apply. In consideration of the granting of this requested perrT it I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans, the Florida Bui di ig Codes and St. Lucie County Amendments. The following building permit applications are exempt r m undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, walls, sil n , screen rooms and accessory uses to another non-residential use WARNING TO OWNER: Your failure to Record i P otice of Commencement may result in paying twice for improvements to your property. A Notice o Commencement must be recorded in the public records of St. Lucie County and posted on the jobsite be a the first inspection. If you intend to obtain financing, consult with lender or an attorney before commeWng work or recording your Notice of Commencement. of Owner/ Lessee/Contractor as Agent for STATE OF FLORIDA COUNTY OF Sworn to (or affirmed) and subscribed before me of Physical Presence or ­-6nline Notarizatio this day of :L�(_ , 2020 by Name of person making statement. Personally Known c---"— OR Produced I Type of Identification Produced TAYLOR GAGNE �.' I -Ay Commission Expires Comm ssi6, Nn_ , January 21, 2023 14 of Contractor/License Holder STATE OF FLORIDA _ COUNTY OF Sworn to (or affirmed) and subscribed before me of P ysical Presence or �: online Notarization this k day of "itc _ (...,,! 2020 by Name of person making statement. Personally Known - OR Produced Identification Type of Identi ---• -- Produced TAYLOR GAGNE s < =1 of Florida 1;ssion # GG 293167 ..v Commission Expires (Signature of i Commission No. (Seal) REVIEWS FRONT ZONING SUPEIRtISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW RE I W REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED AHRI Certified Reference Number: 8215497 AHRI Type: SP-A (Single -Package Air -Conditioner, Air-Ci Series: R410A AC SPP Outdoor Unit Brand Name: BRYANT HEATING AND COI Outdoor Unit Model Number (Condenser or Single Packa Region: All (AK, AL, AR, AZ, CA, CO, CT, E MT, NC, ND, NE, NH, NJ, NM, NV, Territories) 70rff;,4M41i1M Date: 07-08-2021 Model Status: Active .ING SYSTEMS ) : PA4ZNA042000— ** , DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, Y, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY, U.S. Region Note: Central air conditioners manufacture prior to January 1, 2015 are eligible to be installed in all regions until June 30, 2016. Beginning July , 2016 central air conditioners can only be installed in region(s) for which they meet the regional efficier cy requirement. The manufacturer of this BRYANT HEATING AND COOLItIG SYSTEMS product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of A & Air -Source Heat Pump Equipment and subject to rating Cooling Capacity (A2) - Single or High Stage (95F), btuh SEER 14.50 EER (A2) - Single or High Stage (95F) : 11.60 t"Active" Model Status are those that an AHRI Certification Pr( marketed but are not yet being produced."Production Stopped" selling or offering for sale. 1210/240 with Addendum 1, Performance Rating of Unitary Air -Conditioning ;uracy by AHRI-sponsored, independent, third party testing: 000 'anticipant is currently producing AND selling or offering for sale; OR new models that are being Status are those that an AHRI Certification Program Participant is no longer producing BUT is still DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and akes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims al 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 r`tings 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. 7 ils Certificate shall only be used for individual, personal and alias confidential reference purposes. The contents of this Certificate m not, in whole or in part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any fort i or manner or by any means, except for the user's individual, personal and confidential reference. AIR-CONDITIONING, HEATING, & REFRIGERATION INSTITUTE CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verifi d at www.ahridirectory.org, click on "Verify Certificate" link we snake life better^^ and enter the AHRI Certified Reference Number and the date on w ich the certificate was issued, which is listed above, and the Certificate No., which is listed at bot m right. 132702225238549311 ©2021 Air -Conditioning, Heating, and Ref rigerati Institute 'CERTIFICATE NO.: