HomeMy WebLinkAboutBuilding Permit ApplicationmEL mPP4LICABLE INFO MUST BE COMPLETED FOR APPLIC4TIOn TO BE mZEEP, ED
DFtc: I Pcrrmit Nai—,,ocr:
Building Permit Application
rlonniny and Development Services
ouilding and Code rreyularion Division
uuG v iryinio Avenue, Tort Tierce rt zy7ma _
Phone: (772) 462-1553 Fax: (772) 462-1578 C c;rnmercial Re.Aential _
PERMIT APPLICATION FOR: i o Select from dropbox, click arrow at the end of I„ IV
PROPOSED IMPROVEMENT 13CATION: f
Address:
C.gol Dc�criY[ion:
P. vpcR, i a;; j e:
LOL No. i
bite Plan (Came:
Block No. J56:1
Project (Came:
aetpacRs Front 6acR: Rigllt'iae: [erg Citic:
I L)E I AI[Ev DESCRIr I IuN uF wURR: I
Replace AC, eAaut Change cut with -�S-S on, SEER, I M KW AC unit
Cu195TRuCIIuN INFuKMAIlulu:
Additional work to be nertormed under Tis permit—check a �pP y;
In
OnvAc Gas ianR ❑Gas Piping _anattcr ❑windows/Doors
11 L�letTric 0 PlumBing ElaprinKiers E Gener..ty, R.ot Ra.; pitch
iotas aq. Ft of Construction: bcl. Ft. or Fiat Flea:
Co.t or Const. action: $ � .� UtilitiesTlewer ElSep►ic Building rielght:
uvvI4ER/1E55EE: LqN I RAWI uR:
(Came (Came: De^n"s Zacek
At7aress: Company: ARS American Residential Services
City:mkeo , State: KV
1
Zil, Code: q 16 h-1 Fax:
Phone ICo.G031_1- arpq -C„ -4OTn
E -Mail:
Fill in tee imrle Title Holder on next par
e t if different
from .he Owner listed above)
Address: zavU is 19MOY I
amity: vero SeacR btotc: FC
Lip Cope: 31960 FaT,:
Phone No. 772 794• -jaqj
E -Mail: vz--)
state or Lounty [icense: CMC1L4y15J
,f value of cons ruction is $zAG or more, a RECORDED notice or Commencement is regalrcil.
SUPPLEMENTAL CONSTRUCTION LIEN LAVA INFORMATION:
ua:�Ir3MtR/EMGI1,yEER: x Mot mpplicable
MORTGAGE COMPANY: x RRL mpplicable
Name:
Mame:
mddress:
Address:
City: State:
City: )tate:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TIT[E HOLDER: x IGot Applicabie
60NDiRS COMPANY: x Nzt Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zit': Phone:
I certify dlat no worx or installation Mas commence"a prior to tMe issuance or a permit.
5t. Cazie countty� make. ma rcprc�C [-t�t7i, Oat 1'a wanting aad
t mit —.ill aatFlvrlsc Ci -lc er,;,it Flolacr to Build tRe sub;ect structure
wRicn Is in confliM witR any applicasle Rome Owners Rssoclation rules, Bylaws or and covenants that may restrict or proliiBit s=el!
structure. Please consul.. wi,.h your Home Owners Associadon and review your deed for any restrictions which may apply.
In consideration of tn. Srontln6 of tMi. re.jee3tea pc;- m't, I ao FlcrcBy ugrcc tR.t I will, in ail respects, perform the work
in accordance with the approved plans, the Florida Building Codes and 3L. Eucie County >imendments.
I Me rollowing auilMing permit applications are exempt from undergoing a Lull concurrency review: room aasitions,
accessom y structures, swimming pools, fences, wails, signs, screen rooms and accessom yy uses to another non-residential use
WARNING TO OWNER: Your failure .o Record a Notice of Commencemem may resin. in your paying twice for
improvements to your property. A Notice ar Commencement mast Me recorded anu posrea on the;obsite
before the first inspection. if you intend to obtain financing, conbult with lender or an attorney before
t
_ Sianature of 0 er/ Lessee/agent algnature or Cbntra r [icensd FloIQer
STATE OF FLORIDA
C001411TY OF sttuc-
I lie ror ping instrument was acRnowleBgela Blore me
this day of r g 'i � ZC j by
A'Dw"m Zacak
(fa a persona no ging)
isnoturc of to P !ic- stot. or Florida I
Personally Known x OR Produced Identificadon
I V 19 of li9errtificF560191 Yrvaeceu
Commission Ro.5 (Seal)
r Ivry CQIOM13SION IF'uvu7i5;75
Revised ail io1L EXPINEs Februa
ry Cu. <UY 7
STATE OF FLORIDA
COUNIi WP StLvN
I flc for Ing I.',Stre a -t a. acknv..leagca bctore me
this day of, f z'v by
Personally KmawFii x OR Produced laentitication
Iypeor Isenti�ication Prolluceo
I90.5 [Jeal)
Mi Z;i—jMIW1. WO1M a Goof 133:1
ClrIRlfz onruary N.. z'uz i
nivIrms
FROM
COUNTER
c.urvlNO
REVIEW
30PERv13On
REVIEW
PMlg3
REVIEW
IVIHIvGRvvE
REVIEW
VIGETrt1101a
REVIEW
3EA IORICE
REVIEW
DHIE
COMPLETE
IMI IMIS
[� ` El;t. start Data c
141 Installation ork Order
- ESi. C:omp'aiiw" Data
:., q��i1) �6i-;100 e,9650y
2800 u5 Piigfftl4gy 1, vera aan, Corporate Ce !shier
looking -0* g ru rkmri Re•ioenlial Services of Florida. Inc. Relations
Gcan•■0 CiNC:s7s.., G►Co.oe 7Z., Cr-C:,.oze,. 48$61 803.0878
CUSTOM EMAIL
CALL SLi P
ADDRESS
7
A ,
nOR1EPE
c"
WORK PHONE
YOUR
. DESIGN
SIsF IrPE
Q
PESILE-
ITP!
_�9'$
ELF I Idvr
ERI WIT /
i=t rICIENt�T
i
If
$
c
-e
$
$
$
$
$
_..._.$- _--
bUSIOIA[
$
513BTUTAE $
SUBTOTAL $
MOIRTHLYE51.`
MOM jF1
51.' $
RIONiFILYESi." $
UU51uMEK IMMAIS
CU ER IIgFFIA[5
CDSTORILR INrnA[S
w-manty' ..rts add, Ease,
nty:t
Parte r
Wartenty! Puna Lobar
n+preaaar tta_-t Ex�R_gor
t p, -pre- or Flat Exc-Fia,gor
C o-mpmaecr Flooi E71cch—gui
'unless otRerwise noleuu, d warranties are Irom tRe manufacturer.
SPECIFICS OF •
•
SE[EIrIED OPTIvNrAl 02 03
eainerproore- Plywea8 0.YR
0 Ov Ingnt
Isav�,Rowt Reconnect Drain Gne
uFemiailior .......
SUBTOTAL $ . 00
ime Equipment s!� ❑Coilint, 5avar Ki:
0,9
017er,umi'uisier
$oQna
leol.,iion Paas (Pan & Float)
0 Cetdow Unit Pad
Llgaia I It . i-,5_ 1WI: ..." Dreir, 5-1.1y Switm
CI rise vanti..n
tori Rit se Mew Connections
0 DrcNvorTc c�onnecliv"c"
TOTAL 40307-
/al
Ratriawl
art CG D.-jarSQppm, A -:la Eyaipmcm
0 Unnect to existing plenum
� \tTggerani h:pe $epp� am
i l�l�e : 0 Rveor,nvet � Re- RIIaonnaet
a of
G vucl I4tooi wee
t°0O Ne.,, Fa seeps of—ricJ
_
`
D New Duct System
refrigerant Pipe Cover /f� Return Piier�l11,m
K• No- J 'IJSe�eRllaat
❑ No Duct Work
❑ CASR ❑ CHECR#
Expanoivn voli+a
E3 Pue: PFping
[3CRf DFF Cru ?QC51 40r} �C
G I9ecimnic for Meaner
I -stat - ITpe j&S=
❑ El.etrical Wirny
nnect to Misting EIM.B a'Rlt_,- _....
i!
iome service Plan -
V`
EAP APPRUVAL.____.___.___�._�
lectricai ❑ PCO
1 lens 1364 uays7
OUR
/+
® FINANCING* �
omrort Guarantee me Protection Guarantee
I `
4 -Hoer Sarvi,..e Guarani.a 00%E OnoonaaiQnal Monoy-Bocck 13 --Jvw
•r'�r� ••w = Plovad nodi,
.
NOTESl
i
r
•'AR5 io nal re.,pen..iW for Peo;Ziatirin aeetweak. See ie"ne —0 U5n8itie-o on tRe BuoR of IN— ilveanrea ter aetaib-.
• Writta;-i ouaturri oi.tRorimtio" will be v6ta mad before Baginnirig w,y a- axlenaaa 7.uFZ
• ANY CLAIM5 FOR CON5tRUC ION DEFECTS ARE SUBJECT I IHE 190TICE AND CORE PROvISION5 OF CFIAVI LR 5:
FLORIDA STATUTES.
• Ov I EI!' -a RIG1W I v vaNCEL: This Is a home solicitation sale, and if you do not want the aoods or servi..ca, you ._-.ai cei.c
uns agreement by providing written notice to Me seller In person, uy telegram, or by ma;,. I Js notice must indicate that rt
go not want tfle goo= or services and must be dellvereu or postmarked before midmgnt of Me tfllm Business Gay ager yo
sign tflls agreement. If you cancel iflls agreemenii, tfle seller may not Rep all or part or any casfl down payment see tl
reverse side hereof Tor an explanation or Tnm flgfit.
• I aekno-loa„o th,.t rNr rignt in eanvvl n® Been �is_i-e8 to rww vfl —a in =1'nn. m,a-iIn"st-n*.i..n R4r A,nt to cancel, I aethorize t
peffonnanoo of tho -;;ark aebject to all ta,."u ...3 oorlait'e„;; sal forili en tnc rworsa side Rome?, plea t_CZ ZPe.-, evmplat;a :.
Noti..v To Q,,..ar - Dv not of Shia ho a impreroma..t eontnrot in bl.mK You oro r, -.tilled t9 a copy of tRe contract J the tima roe aiy".
Keep it to Vrolqct your Iowa ah s. This home improvement contract ma contain a mort a or otherwise create a lien on your property
Mal co sift i u not pay. Be sureyo un rs• r atone Or hr•,tract efD you sign.
C RSIG URE EPR SEN .
ap � 5
CUSi0MER51GNAT1IRE DATE ,,J�/1� � lrngq�
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certificate of ProductRatings
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I CERTIFICATE Nu.:
' ,i„Ire caarscalr