HomeMy WebLinkAboutBuilding Permit ApplicationALL APpI,IC l ILE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
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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: To Select from dropbox, click Here
PROPOSED IMPROVEMENT LOCATION;'
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Legal Description; �r�-•,--,�� �� , ,
Property Tax 1D #: L
Site Plan Name: Lot No. '
Project game: Block NO.
Setbacks Front Racic:
-�z Right Side: Left Side;
DETAILED DESCRIPTION OF K
CONSTRUCTION .INFORMATION:
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ert is permit -c ec aHVAC Gas Piping
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Electric 1:1 Plumbing L �linSprinklers
Total Sq. Ft of Construction -
Cost of Construction; $
OWNER/LESSEE:
Name
Address: j'111) GWe
City:' ( _
State:.
zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If Value of construction is $2500 or more, a RECORDED
1
rr-7•
_ Shutters
Generator
SFt. of First Floor: _
ilities:]Sewer a Septic
CONTRACTOR;
Windows/Doors
Roof
Building Height: .
Name. C ."--
company: IT
Addr s
City:l"'Cr ,
ZIP Code., 1% G, State:
Cade: Fax "IL
Phone
T -Mall:
State or County License:( :1't 14 n
mencernent is required.
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SUPPLEMENTAL CONSTR
DESIGNER/ENGINEER:
Name: _
Address:
JCTION LIEN LAW INFORMATION
Not Applicable MORTGAGE COMPANY: _ Not Applicable
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Zip:
one:
_.__ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: �NotApplicable
Name: _
Address:
City:_
Zip:
Phone:
1 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. 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 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before a first ins ection. If you intend to obtain financing, consul n attorney before
co enci rc or recor I ur Notice of Commencem
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
-g it
The o Ing instrument was acknowledg d before
this
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Y °f 20by
!
/i
.•lUiilllil..
(Nameyf person acknowledging)
ature of Notary Public- State of Florida )
Personally Known L""_... OR Produced Identification
Type of Identification// Produced
Commission No.SJ_ � / -7 (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
Signature of Contr for/License Holder
STATE OF FLORIDAU; Q �,
COUNTY OF
The for i g ins t as acknowledged befo,
re m , a
this dd of 0 20(o by X 3
(Name ofrson acknowledging )
111111/(p��'
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( ignature of N tary Public- State of Florida)
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No.K`r � p ($eal)
SUPERVISORPLANS I VEGETATION I SIREV RT11 I MRV ROVE
REVIEW REVIEW REVIEW
wwvu.ahridirectary.orgCertificate of Product Ratinas
AHRI Certified Reference Number: 8215494 Date: 7/29/2016
Product: Single -Package Air -Conditioner, Air -Cooled
Model Number: PA4ZNA048000- **
Manufacturer: PAYNE HEATING AND COOLING
Trade/Brand name: PAYNE HEATING AND COOLING
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.
Series name: R410A AC SPP
Manufacturer responsible for the rating of this system combination is PAYNE HEATING AND COOLING
Rated as follows in accordance with AHRI Standard 2101240-2008 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): 47000
EER Rating (Cooling): 11.50
SEER Rating (Cooling): 14.00
IEER Rating (Cooling). -
'
Cooling);
' 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 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;
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entered into a computer database; or otherwise utilized. in any foror 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.ahrid!rectory.org, click on "Verify Certificate" link
and enter the AHRI Certified Reference Number and the date on which the certificate was issued, we make life Neuer'
which is listed above, and the Certificate No., which is listed at bottom right. I
®2014 Air -Conditioning, Heating, and Refrigeration Institute I CERTIFICATE NO.: 131142894283216368