HomeMy WebLinkAboutScanned from a Xerox Multifunction PrinterALi ""- 'CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34.982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
PERMIT APPLICATION FOR: 15=telg,� r
PROPOSED IMPROVE1VIENT10CATION: �C
Address: c5`ff tSeA
Legal Description.
Property Tax ID#: LJO-50$
Site Plan Name: Ve,rv--2
Project Name: 2
Setbacks Front
e4c
Back: Right Side: Left Side:
DETAILED DESGRIPTION OF WORK:
Residential x
rL-- .4'9eZ_
Exact change out o , installed 3 &TV/0 'C k&z4 e_,�
Ac �fl;t t1'( �
5t
NSTR.UCTION INFORMATION:
Lot No. _
Block No.
MVAC
wpluqzl u i rbpermr[—cnech aflappiy:
Gas Tank Gas Piping
n
11 Electric
0 Plumbing Sprinklers
_Shutters
11 Generator
L� Windows/Doors
Roof
Total Sq. Ft of Construction:
5. Ft. of First Floor:
Cost of Construction:
$ S 1 `''� Utilities:ISewer
Q Septic
Building
OWNERAESSEE:
Height:
ht:
CONTRACTOR:
Name
Address: 3le 8 n.[,_ _
City: —C -rT > r -w, V L _ State: FL
Zip Code: 8 L _ Fax: NIA
Phone No. Df'�—
E -Mail: NIA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is
Name: Zack, Dennis
Company: American Residential Services
Address: 2800 US Hwy i
City: Vero Beach
State: FL
Zip Code: 32960 Fax: 772 794-9783
Phone No. 772 794-7221
E -Mail: bderby@ars.com
State or County License: CFC1428283
or more, a RECORDED Notice of Commencement is required.
Ct & )IMPL e Aiwlr. r .,
s-4-1VIL I IML UjuIvs l KQcTION LIEN LAW INFORMATION.
—a.+....�in�uYL111YCtii: x Not Applicable
Name:
Address:
City'State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER- x Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: ph
x Not Applicable
BONDIN6�MPANY: x Not Applicable
Name:
Address:
City:
Zip: Phone:
i certify that no work or installation has commenced prior to the Issuance of a permit.
St. Lucie Count
yy makes no representation that Is granting a permit will authorize the permit holder to build the subject structure
which is in conFlict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or 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,
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
twice far
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 record;- our Notice of Commencement.
1
_ Signature of O �er//Lesssrsee//Aftgent
STATE OF FLORIDA
COUNTY OF smut;.
The forgoing instrument was acknowledged before me
this .,2 day of 20 (-�—by
Dennis Zamk
person ackn ledgi )
of Notary ublic- State
Personally Known x OR Produced identification
Type of identification Produced
Commission No. FF22D930
Revised 07/15/2014
REVIEWS IFRONT I ZONING
COUNTER REVIEW
INITIALS
$}IOMAS H. DABI
NOTARY PUBLIC
Comm# FF128494
Expires 6/2J2018
Signature of Contra r/License Holder s
STATE OF FLORIDA
COUNTY OF si Luce
The forgoing instrument was acknowledged before me
this day of 20 by
Dennis Zack
{Name ofarson acknowh
ature of Notary Puy)lic- State of Florida
Personally Known � OR Produced Identification
Type of Identification Produced
SUPERVISOR PLANS
REVIEW REVIEW
No. FF220930 Seal}
...anr.- TWoM iii. b Ef; .
STATE OF FLORII
Conm# FF126494
VEGETATION SEA TURTLE i MANGROVE
REVIEW REVIEW REVIEW