HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLEINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:0..3,/.",jlf;:;Permit Number:_
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:
Address:~I!.L!-~~~',d-f-''¥-f-J~~I!io.-.!.''!''!='''------------------------
legal Description:Riftu)Oa 0;1
LOf·7 (Of 3(/15::~B7L
Property Tax ID #:.3'-/~tj-tOCf)-0/'dq -~DO -£Lot No.__7L-;-_
Block No.rJ i.£JSitePlanName:_
Project Name:_
Setbacks Front _Back:Right Side:Left Side:_
o Windows/Doors
DRoof
Total Sq.Ft of Construction:_
Cost of Construction:$GOOD flll
S'fB;of First Floor:
Utilities:USewer D Septic Building Height:_
'-/0 .v'e..Company:~m'f.l1tJ.~~/LJ~'f:t!:t.'J.l:t4liJ!.!:J~~i1.
City:c!5J-.State:FL Address:.!!.M~(J.!.f./~/......Ll..j./.d~!.t:Z::.:...!d.'JI..!!.'t1.!:!.~----
Zip Code:~3fjq5::J Fax:________City:Hr-l--lert'~
Phone No.7'l~-3l/01-aQ 3 S"Zip Code:3l./CJ[;l..Fax:77:2-t./ta5-l/9t!.r
E-Mail:Phone No.77;{-Lf~S~/(;O(P
Fill in fee simple Title Holder on next page (if different E-Mail:adVantage IJermlfs @hotmail.@x.
from the Owner listed above)St te or coyntV.Licens:C!fIeo3'1 ~~l'
u w#:688
If value of construction is $2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:~-----------------------Address:------
City:~:__------State:Zip:Phone:_
_Not Applicable MORTGAGE COMPANY:
Name:Addres-s:----------------
City:-=State:
Zip:Phone:_
_Not Applicable
_Not ApplicableFEESIMPLETITLEHOLDER:_Not ApplicableName:_
Address:_
City:-.,-_
Zip:Phone:_
BONDING COMPANY:Name:_
Address:_
City:_
Zip:Phone:_
OWNER/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.LucieCounty makes no representation that is granting a permit will authorize the permit holder to build the subject structurewhichisinconflictwithanyapplicableHomeOwnersAssociationrules,bylaws or and covenants that may restrict or prohibit suchstructure.Please consult Withyour Home Owners 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.LucieCounty 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 your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with lender or an attorney before
commencin work or recordin our Notice of Commencement.
I ature of Owner/Agent!lessee
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Signature of Contractor/License Holder
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TheJ.OJ"gpinginstEnt wfls acknowled~efore me
thi~dayof 'are«:,20~by
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The for~oing inst/il4ent was acknowledged before methisZ1..1'day of 'tJrei<...,201mby
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(Name of person acknowledging)-.....(Name of person acknowledging)
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(ignature of Nota;?b'-StatE>..~riR~J *?~..:.§'o.::.••••••••~~*~v "'\;.,/-l'IREs "v~~
Personally Known o~l5r~;"~ntifici\j~
Type of Identification ProducallU iS2 ::::,~\:'6:=:z .?!!CQ •l 2<»e :::~:a~4 $~:§:::=~Commission No.~•••D~'"(~ilW#•••~~.,..-'4'~~.c..,~~..~\~..~..~~~~
Commission No.---'~--'''''r:--
Revised 07/15/2014
REVIEWS MANGROVE
REVIEW
DATE
RECEIVED
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR PLANS
REVIEW REVIEW
VEGETATION
REVIEW
SEA TURnE
REVIEW
DATE
COMPLETED
A.'1~1CERTIFIEO®
www.ahridirectory.org
This combination qualifies for a Federal Energy
Efficiency Tax Credit when placed in service
between Feb 17,2009 and Dec 31,2016.
Certificate of Product Ratings
AHRI Certified Reference Number:3610304 Date:3/29/2016
Product:Single-Package Heat Pump Air-Source
Model Number:RQPM-A043JK
Manufacturer:RHEEM SALES COMPANY,INC.
Trade/Brand name:RHEEM;RUUD
Series name:RHEEM RQPM SERIES
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:
Cooling Capacity (Btuh):
EER Rating (Cooling):
SEER Rating (Cooling):
Heating Capacity(Btuh)@ 47 F:
42500
12.00
14.00
40000
Region IV HSPF Rating (Heating):8.00
Heating Capacity(Btuh)@ 17 F:22000
•Ratings followed by an asterisk (.)indicate a voluntary rerate of previously published data.unless accompanied with a WAS,which indicates an involuntary rerate.
AIR·CONDITIONING,HEATING,
&REFRIGERATION INSTITUTE
we make life better's
CERTIFICATE NO.: