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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Gaee�, Ga 10 Permit IQumBer:
s s
Building Permit Application
rlw,,,,,,.g—it VU ar�F.... „t5�-
dcr,-Iu.y was wac HcyaluGo" 0;9"- "W"
23OU v;, y,*„,'a Are„ue, Fort Pie, ce FL 34982 _
Phone: (/72) 462-1553 Fax: (772) 462-1578 L.Ommercial R-CAerltial _
PERMIT APPLICATION FOR: To Select from dmpbox: click arrow at the end of line
PRuPuSED IMPROvERIEI9 I WC.A 11014:
Address: �- n
CegalDescription:C'XaCk Ai_ �[_\(1(lY`VqLQ a_)k- Vy)� AuCA- Q
Property pax ID a:
aiLe Plan Mame:
Project Mame:Q
Setbacks Front,
back: RigRt aide: len biu.:
Lot No.
Block No.
DE I RILED DE51LRIP I IuM OF WORK: I
Replace AC, eAaLt change oat with on, SEER, KW HC unit `�� LwvL -
LUM51170ElIVN IIWORIGIAIION: j
Additional work to brtormed under this permit — c ec aftp,-,,:
e eMVRE: Gas ianR ❑Gas Piping Rpttcr. �Windows/Doors
Electric U Plumbing []_)pringlers E Gerrer..tor Roof Root pitch
notal Sq. r► of Construction:s Ft. yr Hr..t Floor:
Cost ei Con;traetion: 1=)t LJtilities:Sewe171
rSeptic Building ReighE:
UVAER/[E55EE:
LUN I FMCWR:
Name
(game: Dennis Zacek
AMUress:
Comeany: ARS American Residential services
City: S.a,e:S�7(.
Address: 1600 05 AWy
Zip Code: Fax:
Ci,y; veto 6eacR Stot�: FL
Phone Ido.
Gip C,0e: 32960 Fax:
E-mail:
PhoneNo. ic�-�`�� •� a�3
Fill I.... icc Impie Title Holder on next page (if different,
E -Mail: � i QsJ • C -L'A'M
from the Owner 16 -ted above)
-itate or Count, Circri.,c: CMC1249753
It varue OT consirucuon is azsuo or more, a RECUROEU 14.tiac eT Cvrnrnerlee... erlt 13 reyeir0.
1 5uPPEEME19 I A[ UUNb I Rue, I JU19 [IEIa LAW INFORMATION:
DESIGNER/ENGINEER' = Not Applicable
Name: _
Address:
City:
Zir:
Phone:
State.
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
City: State'
Zip: Phone:
BONDING COMPANY: X Not Applicable
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
at. [ucie Lounryy mares no representation tRat is granting a permit will autnorize the permit Rolaer to Rui1t7 the select strecterc
which is in conflict with anx a plicable Home Owners AsSOClaLion rules, bylaws or and covenants that may restrict or prohibit sucR
zrreeterc. Pleo,c con.elt ..itl�yoe.- Rom7c 0 -mer.. Asaoci-rion onoyour 8ce8 for any rc,triction, ..n1.cR ..ay .pply.
In consilleration or the granting k tRls requesiea permit, I lio nereffy agree tRat I will, in aii respects, p�Rerm� tRc .erR
i.. accordance witR tree Ppproa,,
pla;, trlc Florida Building Codc5 and 5t. Cacic County Amendments.
The followins building permit applications are exempt from undergoins a full concurrency review: room additions,
accessory structures, swimming pools, rences, walls, signs, screen rooms ..ma acce;moo. , a3ez to omotncr nen-residcmtiol a,e
wAKFVI G 10 OvvMER: Your rtlarc to Ravc,a a Notice oi Cc. ...... ence... e..t may result in Your rayin6 twice for
improvements to your property. A Notice of COmmencement must be recorded and pOsted on the jobsiLe
before the first inspection. If you intEnd to obtain financine, Lz-,n3alt with lender or an attorney before
commencing work or recording your Notice of Commencemeni.
' Jam+s
_ bignaterc et v er/ [e�:icc/A6mmt signature of Contradgrfficensi Molder
a 1 Ao I! OF rL vRIuF►
COUNTY OF atr--
he forgoing in u.r t as acknowledse efore me
tR day o 20 6y
(game of
Dennis Zack
]tat. or Florian )
Pc. jon.11y Rno... x OR Produced Identification
ype or leentirlcation Proaucea
Com,;--iz,ion iQe
a ►''; GOLttR 3uLLIVAN
M, COMMI551UN $ uta0I, U3
Revised 07/15/2014 =
Insrallarion wom v. aeff
. , ■
(772)567-3100
r�r 2800 US Highway 1, Vero Deach, PL 3zaov
IOlakine it right,.merken ,.emocn;iel oernces of Plaripa, 6 c ri,crrse w C.0 i 2.975
Making .1'Kark' EC ° 3008558
Est. Start Dale
E=11.
E=1. Completion D_
Corporal
3, Relotione
(.too) 803-0879
1 CUSTOMER M
l 4III I CALL SLIP
31ZE C _ TY E Lj4 of JU 14
EFFIi.IENvr �.
$
SUBTOTA
MuNTHLY E51' Ti
C.uS I DRIER IMI t In[5
SIZE TYPE
EFFIDENCY
SUBTOTAL $
MONTHEY EST.* zii
`1;U5iUMER IMITIAES
G4,e
51Gt TYPE
EFFICIENCY
3
3
SUBTOTAL $
MONTHLY EST.' $
GFib1OMER INITIALS
Warranty;" Parts Labor vvarranty:" Parts ®Dor vva.penty:" Part= Lazo,
Al
„Comprcuawr Hear Eniich„ngcr i Compressor Heat INchanger %ompressor Hca! Exeh-gcp
'S-oj■■t to .radit F._■ei.a Pw.ided 51 Gr■■n-k,;% Fred iat..wt vol, .f fi.99% f.p 00 ...e�:he. P_ymee: ex,.reple ..eaumoa aro-ame S.'Ovv Pu.,...,se oa
cppro-_1 da:e (APR 7.19461 --h
i paym • fee9C:S p 5+ !s r 3 SV,4141J�; itmvria4n6
eal. ur-- 2.1 errs ine Ac wunf.A=iv arerrrhF�39 du -ifh
first r yrt»rN,fi 9 99°c firt)d .laitymem : air�p a- - time 37.'SL7r1 pnch a. r pre. h
1 p.,—... cis 11 I. L.:.L d wwry.r .y t due with
,esi reqs ! a 9.1pr r zv munit to apurcha3e n ap0 , ym 1 0 d 114 smo .nt_ of $1 1 w -e z zolill..A�■.nllo tr{• a cue
dh a-1 �e pa,,. 4L ed:ntwvzl rote of 9.99% fe. 144 Rren:ha. P_ymenI a.='pie am.5 on. ime $'7vv pp. Ise [x slp Jptiotoma pp. i SJ:Ce) witR
-
payment at $ t a p,ymer;, „r $o2-, — i .a am„n¢eo paymenls ur $e i.07 Puymvnte assume r.ccounI Activation' Charge of s.39 apph■rntnd w do.
"70 first req,i:rod payment. f
U.I.- rrho iw rrm-w, al w.nanties,., 6..m I=- m,.mr,ctorer.
❑ Wvn;hcrprouf
Di=eenR�rt
❑ Lifciimo Egoipmcnt Slab
0 50_Rd 1=vhJiw_ Ped=
❑ Liqu;d Tito Conduit
❑ 5t..rt K;t
efrigerant LL Dryer_
-&origVMRt Pipe
❑ Mew reconnect
-. E3 Rclrigerrmt Pipe Cc:cr
❑ Expansion Valy _
ati=t IypcA_1E
o%onnect to Ex�sting
E',ectricoi
G Mew P ywood Deck
❑ Reconnect Drain Line
❑ Dehumidifier
❑ Coiling 5v, -r Kit
❑ u-alaeer Unit Pad
i=an & Floatr
❑ Flue Venting
❑ Rh., Diin 5..Icty 5 tch ectwcrk Cor ineotioncr
G Seal New connections
PLvnneci to existing PEnum
Support A;;ic Equipmeni
❑ Duct M5 ih.a.n.,
upply I •num
(-- N-1- r.. --p. of work)
❑ Now Rccon„eci
❑ Now Duct System
)'Return Plenum
u Mo Duct vvohr
❑ Now cconncci
❑ Fucl Piping
17 Electronic nip Cleaner _
G Electrical Wiring
❑ Mcai.. Fil;vr
t� Home Sat7ioe Plan -
© rcr
term j364 days?
❑ UV Light -
u RepniB�fiep
Geammice
Service Guarantee
PMi, 4 z7
SELECTI'wv vPTly :1' ❑ 2 ❑
50BTOTAL $
TOTAL $
❑ i,A3M IIUK#
❑ CREDIT CARD (LAST -.*s)
EXP _APPROVAL
u FINANCING*
Pristc 1614 Gm_ranl=a
Unconditional Money -Back cauarantee
udal -102Z/8
'ARS is 1`101 rcaponE b1m fur p -e-27, t.„g aecnrark. 5cc Terms r.nd Conditions on 'rhe back of ;hz document for details.
• Wr Iton Lzstca.cr be ab;-ned before beginn „e ,ny anfo.cxcn aadiil.rnnl or e.iended work.
-ANY CI AIMS FOR CON5I ROCTION DEFEUrb ARE 5U B1ECT TO THE NOTICE AND CORE PROVISIONS OF CHAPTER 558, FLORIDA STATUTES
- BUYER'S RIGHT TO CANCEL' This ie a home olli5tallan awls, rind if yon do not Rant the goods or servi..a,, you may cancel this agree•
mornt by pro-viding writte.-...asilts:10 the sallor i7i paean, by torlelimm, or by moll. This notice r�.oat indicate that you do not want the goods
or awrrlcc., end meet Be dali:ored or postmarked berfo.w midnight of the third boaine97 d..y oftcr y.,o Nign this agreemorni: If you cancel
this egrouman%the ,aller mry rot deep all or port of any yah da -n poym-tit Scor 168 ruiene aiae Fiereaf for an explanation of this right
• I acTincraleage th,l my i sg"t to can -1 F,s Fee,, e.piai,,ed to mm arally and to v nr .,g, wed 1i' ' ata,;, my nyhi to u cl, I .rothoriza the performance of
the -.ark aebteet to a' tonna _nd cendillam3 act forth en th. rarcrae side howl, p'e^ acs opo compI. or.
Bailee to O—or - Qo net aipn this Remo impra-e... ant eo..tnlct in 61.. a era entlu o .. fly of Ute contract wt the times you sign.
r4ep It to "fact yve. leg -1 rights. I nis Rorie Imp.-v:eRlo.-.t„ mtnrct n�::y fain a o iig or otharml.,a crorwty w lion on your property
tiI tWJ-1 be fo �doseaodif you riot pay. Be moons goo o.raarstand all p rislons o roe nua� Eglare you sign.
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CUSTOMER SIGNATURE DAr F.
FRFSF. +
-
0173 _—RteR 3IaRn�eR. a,,:f! T F151-1 -,
-_ _
mun
0 2019 nenResdential Service■ LLClim
. n8 ngllts e—, nRS rmie_FL. 16012. L100124 R.-59