HomeMy WebLinkAboutBuilding Permit Application--------------
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Budding and Code Regulation Division
23001/1"Onla Avenue, Fort Pierce FL 34982
Phone: (772) 462.1553 Fax: (772) 462-1578 Commercial
Residential )
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: -'� I I rl
Legal Description:
Property Tax ID#: a(p-56a-(70Up-(_DOC) 1
Site Plan Name: Lot No.
Project Name: Block No,
Setbacks Front Back: Right Side: LeftSide:
Cru/ f 00} f-lr Gor'At lov " -}b 0. 2)TOn l -j seac O LQer 4e M6�L1
Lk r7H'1o3LPAr100e.A aVI, F12r t+q,rulle.v wwd-et-reMLAO 0-&4e431Sa-
W I`l" l $ K AD ';_�Le CA, -r C. H
Il'+ .'AL L� Gas Tank UGas Piping UShutters
jjWindows/Doors
Electric QPlumbing ❑Sprinklers 12Generator
Generator � Roof
Total Sq. Ft of Construction:
--�_ Sq. Ft, of First Floor:
Cost of Construction: $ ❑
Utilities: Sewer USeptic Building Height:
City: I—pyT-0lent-o_ State:
Zip Code; 3+1q`i� Fax:
Phone No.a3 1- `'t-7'at 3 Lo y
Lp
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: PioLsrLo
Company: S26peplrA Ar S rJIGL
Address: /'�,) mPnatbt.Le�li
City: 92'T 7- L,ltcl�- State: ;I-
ZipCode: 7J2n9.(.a Fax: 7751 q34_-3511
Phone No. -7-7a-g-Zl_i5(ob
E-Mail:�(�-1's/1LQ.-(i sr Yl�l CS
State or County License: C-) $ t gLao
a RECORDED Notice of Commencement Is
DESIGNE 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:
I certify that noo work or installation has commenced prior to the issuance of a permit.
St.
is in contllctawith any applicablelHomeownestAssociationi rulesabylawszor anscermit holder to ow:nants that may restrict osubject
r 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 the first inspection. If you Intend to obtain financing, consult with lender or an attorney before
commencinr record' r Notice of Commencement
S
_ Signature of Owner/ Lessee/Agent
Signature of ontractor/License Holder
STATE OF FLORIDASTATE
COUNTY S- �l;l�'.,l
OF FLORIDA(,- i,_
OF �� e,
COUNTY OF r U'I
The forgoing Instru(nent was acknowledged before me
The forgoing instrument was acknowledged before me
this L�_dayof A\nVet Vhe, 20 ilaby'�
this__q_dayof NbV-e VV-tfZ. 20 AP by
C�� L GQ, L�1 rYSL-V(/
`�L'iV l � �) ✓1C� 2R
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public -State of Florida)
t Igl ature of Notary Public -State of Florida )
�-_
Personally Known OR Produced Identification_
Personally Known OR Produced Identification_
Type of Identification Produced
Type of Identification Produced
LI
Commission No. ""r" N(g A
'n!n ARIE BOUCHAR
Commission No. "'"'- OA MAlkFAbLICHARD
MY COMMISSION #FF125528
•�'•� MY COMMISSION #FFt2552a
Revised 07/15/2014 (aMI5rlLIss ftfld.NMe aeivtt..Ol NOn]B ' ilgippNWB SBryICe.CM,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
This combination qualifies for a Federal Energy
Efficiency Tax Credit when placed in service MR no ED" J
between Feb 17, 2009 and Dec 31, 2016.
Certificate of Product Ratings
AHRI Certified Reference Number: 7567683 Date: 11/4/2016 saaaaaaaas
Product: Split System: Air-Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: 4A7A7036A1
Indoor Unit Model Number: TEM6A0C36H31+TDR
Manufacturer: AMERICAN STANDARD
Trade/Brand name: AMERICAN STANDARD
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, SO, TN, TX,
VY
UT, VA, ll WA, W, WI, W, 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: PLATINUM XM
Manufacturer responsible for the rating of this system combination is AMERICAN STANDARD
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
parry testing:
Cooling Capacity (Btuh): 36200
EER Rating (Cooling): 13.00
SEER Rating (Cooling): 17.00
EER Rating (Cooling):
dons followed by an amedsk (I ineiute a voluntary,erme of previous), published data, unless accpmpaniee vmh a MS, which inaloates an evaw,tary rerele.
DISCLAIMER
AHRI does not endorse the producbs) listed on this CertiNcate 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 Proceeds), or the
nauthodmd alteration of data listed on this Certificate. centered ratings are valid only for models and configurations listed in the
directory At www.ahrldlfectory.erg.
TERMS AND CONDITIONS
This Certificate and Its currents are proprietary products of AHRI. This Cetllflcate shall only b, used for Indlvldual, personal and
confidential reference purpaaea The contents M this Certlflcate may not, in whole or in pari, be reprvduretl; copied: tllsseminateq
entered Into a computer database: or otherwise utilized, In any form or manner or by any means, except for the user's Individual
Widened and confidential rahrence. AINCONOITIONdQ HF NQ
CERTIFICATE VERIFICATION A assa..Fannie. dicamm r
The informHion lw the modeldted ad This lartideth, can be verified at everel ridlreatory,mg click on`Verlfy Certificate' link 1
and enter the AHM Certified Reference Number and the date on which the cetli tsets was issued, w` make 1&M1etmr^
whkh is Rated eb., and the C¢Nflcm¢ No.. which is listed at barrelrighti
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02014 Air-Conditioning, Heating, and Refrigeration Insttute CERTIFICATE NO.: 131227496168419663