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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:~,3./201t..tJ 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 X2{ PERMIT APPLICATION FOR:Mechanical Address:QC6DD L{1 Legal Description:",t-47 PROPOSEDINPROVEMENT LOC~TION: Property Tax ID#:332/7--702 -oolf7-om -ct Site Plan Name:_ Project Name:_ Setbacks Front _ Lot No .._ Block No._ Back:Right Side:Left Side:_ ShuttersDGenerator o Windows/Doors DRoof Total Sq.Ft of Construction:_ Cost of Construction:$3B51?t)J2.. S'f.£!;of First Floor: Utilities:USewer DSeptic Building Height:_ Address:--"-~'"'_7-'"""-'--'~=-~'"-'-*-LV7...L..:...---- City~y+6\-,LLtGl0 State:.a. Zip Code:3...4C\91.p Fax:_---,-_ Phone No.103-23d -,3IDD E-Mail:_ Fill in fee simple Title Holder on next page (if different from the Owner listed above) Address:W2L!~j\JQ rIA e+-_fhJL...!...><..=erLU~e..=___ City:_FO~tea:e.State:FL Zip Code:34£\02.Fax:'772 -%6 -L/Or LIS- Phone No.rJ1l-405-I~Ol,o E-Mail:1!dVQnta0e.:pa:m""b @ hclm~rll.can State PI County License:ere O~~lo LP4 _L:o "'*.65767 If value of construction is $2500 or more,a RECORDED Notice of Commencement is equired. ,,.,',.'"','.'.",7 ,',..,..•...".''7 •-\"--'\4-.""'I7~'Slf;Jp,Rl;:EMEf}JIAb..CONSTRHqlpN lI~NLAWINFO~MA:rION.:. ,i ./:',,...,.:.,,:.:~',;,,".::::'-.'_/'~;~.,.••;.•C',;.'.,;'l,""'",.•,'c'>'".""~'.",'if,e...•...••.,:.,........'.:';.,. DESIGNER/ENGINEER:_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:Name: Address:Address: City:City: Zip:Phone:Zip:Phone: OWNERI 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 coun~makes no representation that is granting a permit will authorize the germ it holder to build the subject structurewhichisinconllctwithanyapplicableHomeOwnersAssociationrules,bylaws or an covenants that may restrict or prohibit suchstructure.Please consult With your 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 S1.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 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 commencing work or recording your Notice of Commencement. IV)<~/'a~~IVJ<b7A~/7tJ~ 'Si'grrature of Owner/Agent/lessee Signature of Contractor/License Holder STATE OF FLORI~d LCt('j~STATE OF FLORI~~'1 Lube:..;COUNTY OF COUNTY OF <;{Jun The for~g ins~nt was aCknowled~efore me The fo~g instrument was acknowledged before methis\3 ay of u...n e..,20 t by this t ayof :I"\..Ln<',20~by Dtrmllel T ~lJrhllJi(Gmt/e!T,hW41£/U/ (Name of person acknowledging)"-(Name of person acknowledging)<; /P 0t~\l\lIll"11./~fPr2_LA I,/~'~~-..ll//,r.0\\\\1111/1/11. (Signature of Notary ~~~fi7f Fr~~(Signature of Nota7-Stat~$~:i!t9)*'~/,z~•••-..(2 Z~"'-<.cttC)'~••\Y~~~,·~'/.I'IRE8 ".~ Personally Known ~if!!cij:pr<l'l~q;~~~cation ___Personally Known O~@~~~~ntifici\i~ Type of Identificatio~<\d 4 §JJ1:Fg~Type of Identification ProduceiLLI if!2::,f %~'5~ ~·.D:;.n ~~••CI:J";::-=z:~~.:&~j:Lu:~•-fJp ~~;:::="2 ~o ~~~1:).::5.J..-:::Commission No.~,".f.'!"$i)Commission No.':;';0 7>(~~~•••~~::o~••••••••«-:s~~.'1'4-•V;~ ~IIIIIJ *NOT 1\~1\\,""~=;~f.0o~~~........~;,,~':,~, "II/.,.'XUTJ\~;\\\"1 Revised 07/15/2014 IIIII/HtIlI\\" REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVECOUNTERREVIEWREVIEWREVIEWREVIEWREVIEWREVIEW DATE RECEIVED DATE COMPLETED A.~~ICERTIFIED@ www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number:7884962 Date:6/13/2016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:RA1424AJ1 Indoor Unit Model Number:RF1T2421MTAN Manufacturer:RHEEM SALES COMPANY,INC. Trade/Brand name:RHEEM;RUUD Region:Southeast and North (AL,AR,DC,DE,FL,GA,HI,KY,LA,MD,MS,NC,OK,SC,TN,TX,VA AK,CO,CT,10,IL,lA,IN,KS,MA,ME,MI,MN,MO,MT,NO,NE,NH,NJ, NY,OH,OR,PA,RI,SO,UT,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. Series name: Manufacturer responsible for the rating ofthissystemcombination isRHEEM SALES COMPANY,I",C. ,',-"::: Rated as follows in accordance withAHRI Standard 21 0/240-2008 for Unitary Air-Conditioning and'Alr-Source Heat Pump Equipment and subject to verification of rating accuracybyAHRI-sponsored,independent,third party testing: Cooling Capacity (Btuh): i::ER Rating (C09Iing): .SEER Rating (Cooling): lEER Rating (Cooling): 23800 12.50 15.00 *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 a"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 AHR!.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 on this certificate can be verified at www.ahridirectory.org.click on "Verify Certificate"link 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.,.,.--..".-..".,.-",-:---------------------1 131103010118215522©2014 Air-Conditioning,Heating,and Refrigeration Institute AIR-CONDITIONING,HEATING, &REFRIGERATION INSTITUTE we make life better?'