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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO 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 ---- PERMIT APPLICATION FOR:To Select from dropbox,click here Address:'2'/1 D 0e LegaI Descri ptio n:--..::......J..l.<~f\.Lr~i~~~-J-..L.L..L.L..:L-..J!....O!..I.'-=!=---l~"""'--.>.-L-~!.L!...:~~"'"""""'-=:l=.----"---""....>.:<..:........:....'='<-"-=:...L-_ L De.CoO -1(0'1 Property Tax ID #:2lfcn-50 \-OD6 '2 -ODD-to Site Plan Name:_ Project Name:_ Setbacks Front _ Lot No.5!~+7 Block No.,3 Back:Right Side:Left Side:_ Shutters D Generator o Windows/Doors DRoof Total Sq.Ft of Construction:_ Cost of Construction:$---.6Y:o.D_Cill._b _ S9:B;of First Floor: Utilities:USewer D Septic Building Height:_ CONTRAGTOR:.OWNER/LES~EE:"'_ Name-.laJoerOllfle Church of })ehVe(Mce Address:ZQ97 AVefU-le..s City:fOr'-+-;0erce State:R.. Zip Code:3LfC1Cf'7 Fax:--:-_ Phone No.71:;l-l./£Q -5'65 <f E-Mail:_ Fill in fee simple Title Holder on next page (if different from the Owner listed above) Name:'-.3amuel T.IN-haM Company:fJdllaofot.Jt:tHe;0+-fh-e 7teosllr~{bsf Address:~(}/~lJI{arl1d /l-VeK.UG City:IV!?+-'feme...State:Fc Zip Code:0q.q82...Fax:772-1./(p~-l.ftlflJ Phone No.'!7J -LIfo ~-Ihl}{p E-Mail:()dt!arr!t1gqJermffs@6a1ma;t ~!;f Sta e or County License:?If!t!D3Q66Y"'.g:887 If value of construction is $2500 or more,a RECORDEDNotice of Commence ent is required. DESIGNER ENGINEER:_Not Applicable MORTGAGE COMPANY: Name:Name:_ Address:Address:-------------,::-c----- City:State:City:-=-:State: Zip:Phone:Zip:Phone:_ _Not Applicable FEE SIMPLE TITLE HOLDER:_Not Applicable Name:_ Address:_ City:--:--:---_ Zip:Phone:_ BONDING COMPANY:Name:_ Address:_ City:._ Zip:Phone:_ _Not Applicable 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,wails,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 I /5/1.'·~1 COUNTY OF ~~{fO Luue:./ Signature of Contractor/License Holder ~~I~T~~Fci~ORI~~II;-(Luc;o The forii~ing instrue>~cknowledmefore methisIDCclayof~,20 l(p by Dflmlfe I T ..))11 rhll/l{. The to~oing instr~e9t yvas acknowledged before me t~~s~day of ~!J4-,20~by Uamllel --/'/- (Name of person acknowledging)--(Name of person acknowledging) Revised 07/15/2014 REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR PLANS REVIEW REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEWDATE RECEIVED DATE COMPLETED A.~!!ICERTIFIEO® www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number:8459158 Date:10/10/2016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:TC4B6021 Indoor Unit Model Number:AE60CX21+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 name:LX SERIES Manufacturer responsible for the rating of this system combination is CHAMPION BY JOHNSON CONTROLS Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning arid Air-Source HeatPump Equipment and subject to verification of rating accuracy by AHRI-sponsored,independent,third party testing: Cooling Capacity (Btuh): EER Rating (Cooling): SEER Rating (Cooling): lEER Rating (Cooling): 56000 12.00 14.25 •Ratings followed by an asterisk n 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.i'i0i ,"-.--"-.--~-.~-.. ©2014 Air-Conditioning,Heating,and Refrigeration Institute AIR-CONDITIONING,HEATING, &REFRIGERATION INSTITUTE we make life better> I CERTIFICATE NO.:131205883539236910