HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ('� �j
Permit Number:�k _ 1 (D J9
9N,W, 111 ' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial__.-_ Residential
2300 Virginia Avenue,Fart Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
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Address: �I�Ip rbaar CovQ.
Property Tax ID#: `t o��� '�a - 0 0 U 4 ` 040 $ ^,T Lot No. _
Site Plan Name: Block No.
Project Name: N aAom ab ierVe
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L-Ne for 1A1-P i6at oo, o _ ion _t1Cp r1k sepr sgskin wok 16Kw
New Electrical Meter Second Electrical Meter_-. _- (Affidavltrequired)
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Additionalwork to be performed under this permit-check all that apply:
Ki)N anical _•^,,,Gas Tank —Gas Piping _Shutters Windows/Doors Y Pond
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
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Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ ao,80" Utilities: _Sewer _Septic Building Height.
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Name oN 0bec le Name: glackukil cl,4
. r►S A le-
Address. 2`4OU 1A6l60ur Clue Company:
City: F-ti P'12mr State: Address: 3 S t.0 log
zip Code: ugN(� Fax_ city: l !trae State:'
Phone No, 1-16tO zip Code:,lj444V Fax:
E-Mail- Qckwe11 Q4 Sbnsae gOl.e Phone No-7 441M ICOO
Fill In fee simple Title Holder on next page(if different E-Mall N ar-We R Ong 900 S aC &A C b
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from the Owner listed,above) State or County License I$A,tD S_I
If value of construction is Z1500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notate of Commencement is required.
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DESIGNER ENGINEER: T 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: I 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 in;dlcated,
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 i
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohlbitJ such
structure.Please consult with your Nome owners Association and review your deed for any restrictions which may apply,
in consideration of the granting of this requested permit,t 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 per 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 properly.A Notice of Commencement must be recorded in the public records of 5t.
Lucie County and 'posted an the jobsite before the first inspection. If you intend to obtain financing,consult
with lender or attorn efore commencin work or recordin our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for owner
STATE OF FLORID
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or online Notarization
this.21 day of 207,_/ by 12?vll
Name of person making stat nt.
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Personally Known OR Produced Idpr;Rjfication_A17//7
Type of Identification Produce41 /"J
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(Signature of atary ubile- ate of Florida) ►nEU55aJ.sPtcEk
s Notary public-State of Florida
lr�g'yfp-7� (Seale_
Commission N4. ) ( � � LoIn1n155ianflGGZBd679
;;poi ' MY Comm.Expires Feb 11,20Z3
"" Banded through National Notary Assn,
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLL MANGROVE
7.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I
RECEIVED I
DATE
COMPLETED
Rev 51,20121 I
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Eligible for Federal Tax Credit
AWWWalp II
CertifiCate of Product R"atings
AMR[Certmed Reference Number:201860278 Date:07-21-2021 Model Status:Active
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AHR[Type;RCU-A CH(Split Systam:Air-Cooled Condensing Unit,Coil with Slower)
S0600:16 SEER HIGH EER W SERIES R410A AC
Outdoor Unit:Brand Name'I;:GRANDAIRL �
Outdoor knit Model Number (Condenser or Single Package):WCA6424GKA*'
Indoor Unit Model Number(Evaporator andlor Air Handler)A WAXL484A*
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Region; Al(AK,AL,AR,AZ,CA,CO,CT,DC,DE,FL,GA,HI,ID,IL,A(N,KS,KY,LA,MA,MD,ME,MI,MN,MO,MS, '
MT,i NC,ND,NE,NH,NJ,NM,NV,NY,OH,OK,OR,PA,RI,$C,SD,TN,TX,UT,VA,VT,WA,WV,Wl,WY,U.S.
Territories)
Region Note; Central air conditioners manufactured prior to January 1,2015 are aligible 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 afflclency requirement.
The manuf®ctute�bf ihls•GRANDAIRE:product is tespbpsible fnr gt�rating:of this system eonihin$tlon:.`
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Raked agfri{tows in accordance witti:tl,e latest edition of AHRI 210/240'drith'llddendum..1',.Perfotmehca kta ng,of17n1tary Air-Conditipning
&Alr-Sotirtxr,HeatPump'-Equipment and supjectto rating a tiracy by AHW portsorad,'Iriiiep®ndent third party festin4= ,
Cooling Capacity(A2)-5i gle or High Stage(95F),btuh:40000".
SEER:jS-O0.•' :
EEI2(A2); Singlo:qi Mig)i Stage(85F)I:13.00 .
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producing AND aelrin or offering for agile;OR now models that are being
t°Active°Model Siahls are those that an AHRI Cert�Catfon Program Participant is currently p � 9 fi
marketed butane not yet being pro04cee Production Stropped°Model SUitus are those that an AKRI CeruNcation Program Participant le no longer producing BUT Ile Bull
$Blring or offedng for sale.
RAt�ngs�hat are acco Wanted by WAS Indleatean involutda ro-rate.DISCLAIMER i
Yfte new aubllahad reFntl i� s 3oowr�lo�,jj with the orevidus(Le-WASS_tgSinR.
AHRI does not endorse the prodpciis)listed on this Certificate anti fnaKes no representations,vmnanoes or guarantees as to,and assumes no responsibility for,
the product(3)listed on this Certificate,AHRI expreasty disclalms all liauuity for damages of any(jpo a)wng out of the use yr perrormencs of the pr0(luct(s),or the
unauthorized altcra'Non of data;Itsted an this Certificate-cenfMA ratings am vatid only Tor models and copfi9duations listed In the
directory at www.ahrldireatpry,bfg.
TERMS AND CONDITIONS
This Certificate and its contents are praprfetary products of AHI3L This Ccrtlfialte alkali oaty be used for Individual,personal and is Ila
cortodentiai reference purposes.The contents of this Certificate may not,In whole or in part,be reproduced;opted;disseminated; ArMN
sm,
entered into a Computer database;or otherwise utilized,In any form at manner or by erw means,except for the utor's individual,
personal and rwrrrrdential reference_ AIR-CONt11TItININ6,HEATINe,
CERTIFICATE VERIFICATION sr Rf FarfaEnarioN INSTITUTE
The Information for the model cited on this Certificate can be vedfied tit w%vw.ahrldlreatory erg,cllck on"Verify certificate"link we matte life baner,I
and enter the AHRI Certified Reference Number and the date on which the certificate was issued, _
which I$1isted shove,and the Certificate No-,which Is 11SW at bottom right. ""
1 1-; 1327134(90700i77.i92
@2021 Air-Conditioning,Heating,and Refrigeration InstltUte CER7I01CATE'NO.-
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