HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:~I It IZollo 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
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Address:1\3 N.T -95"(.I -C\5 Noy-l-h1)bund Kes+Area)
Legal Description:ml k [\J\?Ly'I~12.it-\33
Property Tax 10 #:ex 303 -1....!.\....:....I----=D:::....:D=..!...£aJ.....l5..L._-...!::O~D~D~B..L.__Lot No._
Block No._Site Plan Name:_
Project Name:_
Setbacks Front _Back:Right Side:Left Side:_
I DETAltED'D~S$?RLpnQN OF WORK::'~'1
Ale.QX'O.¥OtG+j li lAe -Cor 1,I~eJ'bJd511bi~hl ~)lni-Spl',+.~+--L1?--lou-c:.!..m..:..::jp="",,-'_
ffiUz..G.I...ICOk)A-j M~ZbLI£)N(:\,1,5 :60,~O.5 ~e-eR-,
Shutters
D Generator
oWindows/Doors
DRoof
Total Sq.Ft of Construction:_
Cost of Construction:$_l-i.;...:.\.>..<D ....••D'--Q.P-_
S'f.£!;of First Floor:
Utilities:USewer D Septic Building Height:_
Name:6Amue\--r u r-hcu""
Company:Aohlan+-a~Alt o.p·the·Trea5ur~
Address:loOI S.n10 r (teA..Av=en.c....::.u"'--~-=--_
City:G;t-l-''+Jteae..State:8-
Zip Code:34LlC6 2 Fax:'1'1;).-l}(o '5 .4q \.fS"
Phone No,'11J -W<o t5 'IloD{P
E-Mail:advantage perm',fs@hotrrniLCt)m
Stat or County License:~Lf
OW~ER/LE:SSEE:".CONTRA€:~0R:
Name~oJ·e..0+Flo ri diA OT
Address:3YDD~)Cornme(evil "B\uCV.
City:~+~Lct~~de.rdi~.Je-State:fL
Zip Code:3'3"3 CJ .~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 Notice of Commenceme
'SlJPPLEMENTACCONSTRUCIlONfIEN LAW INFORMATION:.',"·~:·-:i)~·:...~,
'.:"-',','",:,;.'.,--,'.,-',--.'
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 countil makes no representation that is granting a permit will authorize the germ it holder to build the subject structurewhichisinconlictwithanyapplicableHomeOwnersAssociationrules,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.
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'~gr(ature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FlORI~d Lutt~STATE OF FLORI~.-{Luc;eJCOUNTYOFif,COUNTY OF ()t.tn
The forgoing instr~t was aCknowled~efore me The for.ging instrument was acknowledged before methisl'1t:!!.day of &t6t '20 II?by t~d'Y of Ih<~u'".20y;jJ by
CQ .-r D .f(2nu/eJ T,))tt rm.l4/~lImllel ."'--tt Fhtl!J{
(Name of person acknowledging)"-(Name of person acknowledging)
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(Signature of Notary~~f§f Fr61~(Signature of t:»:Stat~~.~i.!t9J••~·'%-1'l"~0:~~\e,-,\y~~~.·~'j..I'IRES -·.0-0
Personally Known --l~'prott~<i~~ication Personally Known oRi&~¢I}~ntifjci'oi~
Type of Identificatio~~~d ~.§i~:.'~§---Type of Identification ProductS1LJ.'if!?;;:,'6-'~~'5~
.-A'-•0 ~tf:;.J;-?s"~:;=~:~~·&~~:UJ;:~-••V..f.L ~~~."•.~::&:~o~~<::s ~§.I-.::::Commission No.~"'11'-,\",!.~)Commission No..~'P,/"(~~tt~.:~~~••••••••••~\3~~-••'/p K~~o~·CJ:..~'/111111*NOTf"?-~\\\\~%~.........~~~~~,-"1111,/.~OT~!,::\\,.•..'
Revised 07/15/2014 11/11I11\1\\\"
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVECOUNTERREVIEWREVIEWREVIEWREVIEWREVIEWREVIEW
DATE
RECEIVED
DATE
COMPLETED
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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 Product 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:
Cooling Capacity (Btuh):
EER Rating (Cooling):
SEER Rating (Cooling):
HeatingCapacity(Btuh)@ 47 F:
18000
13.40
20.50
21600
RegionW HSPF Rating (Heating):11.20
Heatlng.Gapacity(Btuh)@ 17F:'13800
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 ACC\),RATE.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,
;;~~;s:i:_~~;~~~~~tn~~r~::t;i~;::~~~~;~~;:~:;;:~;~:;;tute rC;ERT'I~ICATE'-N-O~~'-
AIR-CONDITIONING,HEATING,
&REFRIGERATION INSTITUTE
131159344641423486·