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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 4�Permit Number: J o ' 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 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSEfl IMPROVEMENT LOCATION: Address: Legal Description: T—(C ' f 'T (, S L _ C A roperty Tax ID #• �2 - Site Plan Name: Lot No. Block No. Project Name: Setbacks Front Back: Right Side: Left Side: -71 ETA ILED.DESCRIPTION OF WORK: (_T CONSTRUCTION INFORMATION: it�ona wo to e e formedunder this permit - c ar a + i+ nnn in: .VAC Gas Tank aGas Piping Electric Q Plumbing Sprinklers Shutters Q Windows/Doors Generator ED Roof Roof pitch Total Sq. Ft of Construction: S . Ft. Sewer of First Floor: Cost of Construction: $ C) � Utilities:nSeptic Building Height: OWNER/LESSEE; CONTRACTQR: Name �� G-i L o� r—�c.-�"-- Address: i,f— t--(�L i /3 r : ! City: -- \ ` r-\ Z State Code � : � Zip : - Fax:. Name• _.�-�� � r. �% Company:_ Addr s e s: _f / S S. �L��e City: C r--i r7.`- c. � State: eL(—'. Phone No. Zip C de: 3 gSS3 Fax: E-Mail: Phone No. -- E-Mail: Z,' 6 o Fill in fee simple Title Holder on next page ( if different from the Owner listed above) State or County License: C_ A e n. rowa yr %;vnmrucnon is lL*uu or more, a Ktccmutu notice or wmmencement is required. Name: Address: city. ' State: Zip: Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Not Applicable Name: Address; City.- Zlp __ Phone: State: IING COMPANY: `Not Applicable is: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicate I certify that no work or installation has commenced prior to the issuance of a permit. d. St. Luc!e County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or an�covenants that may restrict r structure. Please consult with your Home Owners Association and review your deed for an restrictions which may apply. Y Y o prohibit such 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 undergoinga 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 our a • twice for improvements to your property. A Notice of Commencement must be recorded and your paying jobsite before the first inspection. if you intend to obtain financing, consult with lender or an attorney before commencen work or recordin our Notice of Commenr_pman+ lgnature of Owner/ Lessee/Contractor as Agent for owner' STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this --Ll_ day of >� 201:�k by Name of person king smtement Personally Known O Type of Identification R produced identification Produced (Signature of Notary �Pnhri,_ Cry}e -, w,.._ . `0 y PCB.,, TAY L O R GA rY Commission State 93 67 =* *= Commission # GG 293167 My Commission Expires January 21, 2023 Sig /ature a ntractor/License Holder STATE OF FLORIDA COUNTYOF S 7— The forgoing instrument was acknowledged before me this day of _` •-N 20.2�by Name of � Person making statement Personally Known_ FOR Produced Identification Type of Identification Produced (Signature of �!Dtarvlsleh .�_ c+�.y .-,� r— Commission REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION IAA COUNTER REVIEW REVIEW REVIEW REVIEW DA Rev. 8/2/17 TAYLOR GAGNE Notary Public Sta�orida ommission # 167 My Commission Expires January 21, 2023 SEA TURTLE MANGROVE REVIEW REVIEW .�+i,■:�1 CERTIFIED° www.ahridirectory.orgCertificate of Product Ratinas AHRI Certified Reference Number: 202717826 Date: 01-11-2022 Model Status: Active AHRI Type: SP-A (Single -Package Air -Conditioner, Air -Cooled) Outdoor Unit Brand Name: BRYANT HEATING AND COOLING SYSTEMS Outdoor Unit Model Number (Condenser or Single Package) : PA4ZNB030" 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, NC, 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 BRYANT HEATING AND COOLING SYSTEMS product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of AHRI 210/240 - 2017 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 : 28600 SEER: 14.00 EER (A2) - Single or High Stage (95F) : 11.50 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 sate. Ratings that are accompanied by WAS indicate an involuntary re -rate The new Dublished ratino is shown along with the Drevious (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.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; �■ r entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, 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 we make life better - 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. ©2022Air-Conditioning, Heating, and Refrigeration Institute 1 CERTIFICATE NO.: 132863885082019670