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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:CA/IIDI2.0lv Permit Number:_ _.JZ:;'.~'~~"-.i!"'<>..•.~,.,!,;;.,,:,J -'... e".....~- 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---L&-"'----- o Windows/Doors DRoof Total Sq.Ft of Construction:_ Cost of Construction:$385D OQ.. S'f.£!;of First Floor: Utilities:USewer D Septic Building Height:_ PERMIT APPLICATION FOR:To Select from dropbox,click here PROPOSED INPROVI:MENT LOCATION: Address:e eo -=Roo..d LegaIDescription:(a.ke.(~DJ7ar~-Uni+lo-13LK (04 Usr l./[HAP 13!D2S)(oY?(0(04#/(oB(p : 111.07 -212') Lot No._tf--'--__ Block No.toyPropertyTaxID#:130\-(00(0-0138-DOO-3 Site Plan Name:_ Project Name:_ Setbacks Front _Back:Right Side:Left Side:_ I DET~RED DESCRIPTI~N OFWQRK:~ Name:Qamte\\.UrMrncompany':t~~('.~easu(,,-l1ls~ Address:l r }- City:EO r~~~e..,State:R. Zip Code:3:l92>?d Fax:112-%5-'1't4:S- Phone No.711-4<0'5 ---I\cctp E-Mail:QCh)/l.f1.\-Q~term-l.\5@hotrr.lrl\.COWl StaAeor County License:CAr-D 3ql.o~lf ULt.Gc it :~1 Ale,Ch~t1Of OU:tj (i\J,e.hlr'l\~j TC-4-t\30c:?-I"AP30e,Xc?l-tIXV,3.5-+6)1/ 2.6 -tDn:\4.d5 5~1 ~..::.;ol6V--'-=----_ jI·CD~l{.{~~RrLESS:EE;j ,;d'',_..,·......••..'9 Name nda..l \t el Address:'l1Q\.J ~colA.Qcx:u:1 City:£0 y'~:P\er-~~ Zip Code:3Y05\Fax:_ Phone No.11~-5'11-~1)U1 E-Mail:------------------------------- Fill in fee simple Title Holder on next page (if different from the Owner listed above) State:fL If value of construction is $2500 or more,a RECORDED Notice of Commenceme is required. DESIGNER ENGINEER:_Not Applicable Name:_ Address:--::::--:_ City:State: Zip:Phone:_ _Not ApplicableMORTGAGECOMPANY: Name:_ Address:-=-:-_ City:-=-:-State: Zip:Phone:_ _Not ApplicableFEESIMPLETITLEHOLDER:_Not Applicable Name:_ 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.Lucie County 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 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 commencin work or recordin our Notice of Commencement. I ature of Owner!Agent!Lessee STATE OF FLORI~(/'t L'~) COUNTY OF ~::tlIIO CtC1U Signature of Contractor/License Holder STATE OF FlORID'A (7~J I 4 COUNTY OF \.•)!lttnt LtlCt'O The fo~oing instrument was acknowled~efore me this 1(0-day of Sa-e~r ,20t!!e.l bycS'-J~~'~f/li1l/t::/f.~~1I rh II/}( The forgoing instrument was acknowledged before me th~'~d'YOf ~n;k~'20~~'bY uanu.lel T:c ,f (Name of person acknowledging)"-(Name of person acknowledging) \\11111111 (Signature of Nota;7ub'-Statf':()ri!tCJ.l *(~~..~'...•••V/:r~~.f)"stI'IRES <••00 Personally Known oRl&~;"~~ntifjc~\j~ Type of Identification ProduccilllL':~::::,'ff'~~'6~-:Z.~I;Q •(e ....t>---~~~~~~~~~j:f:!:~Commission No..::;;••v;n (~<ll '-h~/~~ ~d.lp "'."'~~=;'t\O,,:~oG~~~~'\;~' Revised 07/15/2014 REVIEWS MANGROVE REVIEW DATE RECEIVED FRONT COUNTER ZONING REVIEW SUPERVISOR PLANS REVIEW REVIEW VEGETATION REVIEW SEA TURTLE REVIEW DATE COMPLETED A.~91CERTlfIED@ www.ahridirectory.org Certificat uct s AHRI Certified Reference Number:8456855 Date:9/16/2016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:TC4B3021 Indoor Unit Model Number:AP30BX21+TXV Manufacturer:CHAMPION BY JOHNSON CONTROLS Trade/Brand name:CHAMPION HEATING AND COOLING 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 na.me:.LX SERIES Manufactur'~r.·reSP()nSible.forthe rating of this system combination ...isCH~MPIONBY'JOHNS()~iCONJROLS Rated~Sfollows ir1aCCOr~ance with AHRI Standard 210/24o.-200~for UhitaryAir-Conditioningand~ir:Source HeatPym~t;quipment and subject to verification of rating accuracy by AHRI~sponsored,independent,>third partyfesting:-"s .. Cooling CapaCity (Btuh): EE~Ratir19 (Cooling):/.,-..;:~ ..SEER Ratil1g (Cooling): lEER Rating (Cooling): 11.75 14.25 ,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.ahridlrectory.orgv 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.i~;1;rrf}}.7;'.~;-7--'CC-:-------------------------~----"--'- ©2014 Air-Conditioning,Heating,and Refrigeration Institute iiCERTIFICATE NO.: 1 AIR ..CONOITIONING,HEATING, &REFRIGERATION INSTITUTE we make life betrer'"