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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLEINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:~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 ---- To Select from dropbox,click here Legal Description:0'11 \-e..1'Y\..a.x~(:t:\133 PropertyTaxID#:cQ303-1\\-OD~5-o(jo8 Lot No._ Block No._Site Plan Name:_ Project Name:_ Setbacks Front _Back:Right Side:Left Side:_ o Windows/Doors DRoof Total Sq.Ft of Construction:_ Cost of Construction:$_l-f....:...1-~bD.::....-Q9._ S~of First Floor: Utilities:USewer D Septic Building Height:_ Add ress:.::-....7-==-=..,.=...=-...:...""""T"''4--l....:..!...!...-''=::!.~~___!:=:::..!..~'':_'_ City:-ip~~~l..C!o.<~L....J....,:~~"--_ Zip Code:..£30q Fax:_ Phone No._ E-Mail:_ Fill in fee simple Title Holder on next page (if different from the Owner listed above) Company:rr\();A- Ad dress:1.LaLS,-'.L.ffia'-"04..!-r!..LV?et=..!-....!.......!..--=---::-__ City:.EQi}'---VIf?(ce State:F"C- Zip Code:~g2..Fax:rJrt:l-LflP6 ·LfCiLf~ Phone No.11~6.J(POlp E-Mail:ad vaf1iriqtpef1hib G2hohmi I.tom S te or County Li ense:1Yt~O~ ~ If value of construction is $2500 or more,a RECORDED Notice of Commence '.,'.,"~',•.~."::~'."",,'C '~':,,},:':;~C·'".'",.'gSUPPLEMENTALCONSTRUCTIONLlEN"LAW INFORMATION:'.j,';.:-..:""."".<,','c','\.,,"," 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: 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.Lucie Countx makes no representation that is granting a permit will authorize the germ it holder to build the subject structurewhichisinconIictwithanyapplicableHomeOwnersASSOCiationrules,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 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 the first inspection.If you intend to obtain financing,consult with lender or an attorney before commencing work or recording your Notice of Commencement. lv,<~//'1L~1 IVJ<b1/>~/7;J~ ,~gr(ature of Owner!Agent!Lessee Signature of Contractor/license Holder STATE OF FLORII(A ~d Lut!t~STATE OF FLORI~~~.LD~COUNTY OF <,,{f,COUNTY OF ()anl The f0.\r'ing instrument was aCknowled~efore me The forgoing instr~was acknowledged before methis~day of Ay.~(,61-,20 by t~d'Y of '"•20']hy Dflmw/T 0ltrhlltJ{drn l/eJ 'T(})il rk/&/ (Name of person acknowledging).••......(Name of person acknowledging) -/k'.,~\I'''''''J1''''L.,~Pf2.L1Aj-j..fy,//./",-\\111111" (Signature of Notary ..••~~~F6f Froi~(Signature of Nota?-Stat~~t~:'i!t9.l ••:·'%~,~0 !(.\)\~·fI \Y~~~"~'l-I'IREs ".0~Personally Known --f~'Profl~"eG,~~cation Personally Known o~~~~~Mkntificci~~~~•~..c::~._---Type of Identification Produccillu,i¥j;;::,~~~'6~Type of Identificatio~<%d 4 ~l-?:~~ .~A \<??~~!/VJ~=~:;2~•&~~:l1.J=~•-If;;"~'-:;2..~O~~es i;§.I-.:;:Commission No.~••••~~.,,:li)Commission No.':;.U '"(~~~:~~~•••••••'(\$~~-ff.74 :••v,§. '/11111/NOiI\~\",~~..~(:,'{'oto ~~~•••••.••(J.~,~,~ "1111 ,,'.':UTA.~,\,,, Revised 07/15/2014 11/1111111I"\' REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVECOUNTERREVIEWREVIEWREVIEWREVIEWREVIEWREVIEW DATE RECEIVED DATE COMPLETED A.~~ICERTIFIED® 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 Pro uct Ratings AHRI Certified Reference Number:8715785 Date:8/17/2016 Product:Variable Speed Mini-Split Heat Pump,with Remote Outdoor Unit Air-Source,Free Delivery Outdoor Unit Model Number:MUZ-GL 18NA-U1 Indoor Unit Model Number:MSZ-GL 18NA-U1 Manufacturer:MITSUBISHI ELECTRIC COOLING &HEATING Trade/Brand name:MR.SLIM Series name: Manufacturer responsible for the rating of this system combination is MITSUBISHI ELECTRIC COOLING & HEATING 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: CERTIFIED RATINGS FOR VARIABLE-SPEED,MINI-AND MULTI-SPLIT SYSTEMS ARE VALID FOR ALL COMBINATIONS OF INDOOR UNITS (BASED ON COMBINATION TYPES)WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OF CERTIFIED EQUIPMENT.VISIT WWW.AHRIDIRECTORY.ORG TO VERIFY THAT THIS COMBINATION IS AN ACTIVE LISTING AND THE DATA LISTED ON THIS CERTIFICATE IS ACCURATE.SEARCH ON THE AHRI REFERENCE #TO QUICKLY LOCATE THIS COMBINATION IN THE DIRECTORY .•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; 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.~-.-;::----- ©2014 Air-Conditioning,Heating,and Refrigeration Institute ""CERTIFICATE NO.: AIR-CONOITIONING,HEATING, &REFRIGERATION INSTITUTE we make !i:tt.~better:"