HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLI INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 ` Permit Number:
n L ,LU
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: rC0Mt a IC, 1 1p'+
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
4 'A On - 1 A- s'E'E R- 1 b Lug n a -A --
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
(Affidavit required)
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors _ Pond
Roof Pitch
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
Name {(Q `_n CAU-1-} Name: IV VpC W V
Address: Up Q-1 C1 pan iSV) LA ICE, B1VJ Company:
City: Fnr Pi eC ce State: 'E L Address: 6
Zip Code: Fax: City: v f 'M bfoa' h State: -
Phone No. l—iZ - 59 5 - 35 9 b E- Zip Code: 2C1�p2 Fax: - 2q -C1
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail 1Si8Lf QWA alC
from the Owner listed above) State or County License 0- AC I B15 `5q
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
►1-1
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City: _
Zip: _
Phone:
UWNER/ 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 attornev before commencing work or recnrdina vniir Nntira nf (nmmonromcnt
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF i rlA1 �� V `y `er
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _7, day of DeC 2Mf 2021 by
coax, wtC)od
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced (� _ ..Y� 0-A Yu*
uI JYAQ
D�
(Signature of Notary PublU State of Florida)
Commission No. (Seal)
Notary Pi &
s
State of Florida
CvOft MO
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ETATION
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DATE
RECEIVED
DATE
COMPLETED
ev 10/12/21
CERTIFIEDoll
www,ahridirectory.orgCertificate of Product Ratinal
AHRI Certified Reference Number: 7492912 Date : 12-01-2021 Model Status : Active
AHRI Type: SP-A (Single -Package Air -Conditioner, Air -Cooled)
Series: R41 OA AC SPP
Outdoor Unit Brand Name: GRANDAIRE
Outdoor Unit Model Number (Condenser or Single Package) : WJA448000K"'OA
Region : All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS,
MT, NO, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, 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 GRANDAIRE product is responsible for the rating of this system combination.
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
selling or offering for sale.
Ratings that are accompanied by WAS indicate an involuntary re -rate The new Dublished ratina is shown alono with the orevious (i.e. WAS) rating
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.ahrldlrectory.org.
TERMS AND CONDITIONS
This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and 151101
II
confidential reference purposes. The contents of this Certificate may not, In whole or in part, be reproduced; copied; disseminated;
entered Into a computer database; or otherwise utilized, In any form or manner or by any means, except for the user's individual,
JF%m SWISS
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 Grp, rr ek _ litt, 1. o " 't
and enter the AHRI Certified Reference Number and the date on which the certificate was issued,
which is listed above, and the Certificate No., which is listed at bottom right. .. - -
OO 2021 Air -Conditioning, Heating, and Refrigeration Institute taFiCATE NO." 132828646875912DBS