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HomeMy WebLinkAboutSUBMITTED PAPERSPlanning & Development Services Building & Code Regulations Division :OUNTY 2300 Virginia Ave. S • Fort Pierce, FL 34982 Cq (772)462-1553 St Y��� SPECIALTY PERMIT APPLICATION Qc,e COUPty ❑ Electrical ❑ Plumbing ICJ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: /4�/ S ©e eAn) a _ 2,2 2. Parcel ID Number: 41s/1 - 6,10 - 610 919 - 00c) - 8 Office Use Only Section I Township Range Map Page Zoning Land Use Initials klj�_ LKSI� 3. Complete Description of Project or Work: AA Lv„+ti ivec-1 S.S 7b,'O 15 SMO- /'4ca, r:e d efv; /O ff, IVea7 Llama L, ate 4. Owners Information 5. Contractors Information Name: ,C19/ it e SC{-, U1 g'n) FL Reg/Cert #: L Address: /3?D 06?Ati A,L 13-10 CountyCert#: ditloa City: .52,e /31-j 5A % State: A)J. Business Name: S7 / JcA_ -Alb, J' 9( L . 7j_ c . Zip: /) Z? (o d Phone: %3�- S -aa�% Phone:77,2 y1*7-3,96b Fax: ?2,7- Work" 9,214, �1� 6. Value of Construction: $ woo sue- OWNER'S'AFFIDAvrr: I certify that all of the information contained in this application is correct and that all work will be done in compliance with all applicable laws regula mig construction and zoning. PRINT OWNER OR CONTRACTOR NAME b4NATURE OF OWNER OR CONTRACTOR STATE OF FLORIDPA; COW- � `� I p ACI DGED BEFORE S DAY O 20 l CD CJ WHO IS PERSONALLY KNOWN TO COMMISSION OR WHO HA$ PRODUCED TYPE OR PRINT OF NOTAR Al. NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 Revised 04/26/2010 ti■maI CERTIFIEDTM www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number: 1076045 Date: 1/6/2014 Product: Year -Round Single -Package Air -Conditioner, Air -Cooled Model Number: RSNM-A042JK Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM, RUUD Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third party testing: Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. 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 afteration 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; 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. CERTIFICATE VERIFICATION ��' The information for the model cited an this certificate can be verified at www.ahridirectory.org, Air -Conditioning, Heating, click on `Verify Certificate" link and enterthe AHRI Certified Reference Number and the date on A..� `' and Refrigeration Institute which the certificate was issued, which is listed above, and the Certificate No., which is listed below. ©2013 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130335109408320832