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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: © MOM Building Permit Application Planning and Development Services Building and Code Regulation Division, MAY 29 (J i 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residen i�T• Lu Co nty, Permitting PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION y „� 1i < Address: J Legal Description: _13530(&Q o-A l U L rA 5 and IY i4.0w dor 9VA N o0 000 "'A w ► 51 Ig3S3 t-nas 1 0 03 l W 223.00.1-1 q5 3a 1ZD-1Z t TH6O o�°'e7 Property Tax ID#: �4- Lot No. Site Plan Name: Q�, o A:k ` an 8Q �� 21 N (UW CJ[(01)4�NBlockN. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF 1NORK T' Replace AC, exact change out with on, SEER, KW AC unit CONS RIJCTIO:N,INFORMATIO`N Add itiona I work to be erformed under this permit-check all appy: VHVAC Gas Tank []Gas PipingM Shutters ❑Windows/Doors 11 Electric F-1PlumbingSprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: QQ S Ft. of First Floor: q.�� Utilities: Building Cost of Construction:$ CKOO 01NN R/:.LESSEE GONTRACTCR ` f Name on_ Name: Dennis Zacek Address: (-�1 ( \ 1S Company: ARS American Residential Services City: -1(1\f1()aState:_M D Address: 2800 US Hwy 1 Zip Code:05�95` 0 Fax: City: Vero Beach State:FL Phone No•-11`1' 0 ()_1W b) Zip Code: 32960 Fax: E-Mail: Phone No. Fill in fee simple Title Holder on next page(if different E-Mail: r��� from the Owner listed above) State or County License: CMC1249753 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTIOeN LIEN LAIN INFORMATION . _ _ --..... . ..._ _ .,_... . . DESIGNER ENGINEER: x Not A ficable _ - x pp MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Ph ne: Zip: Ph n FEE SIMPLE TITLE HOLR: x Not Applicable BONDING COMPANY: X Not Applicable Name: Name: Address: Address: City: City: Zip: Pho e: IZip: Pho e: 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 thepermit 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 II will,in all respects,perform the work in accord nce with the approved plans,the Florida Building Codes and St.Lucie ounty 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 commencing work or recording our Notice of Commencement. Jer :� Scor s _Signature of 0 er/Lessee/Age'nt ". Signature of Contra r/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF St Lucie COUNTY OF St Lucie The Ding instrument was acknowledge efore me Theo Ding instrument was acknowledged efore me this day of 20 Ay thisCLV day of 20 "by Dennis Zacek Dennis Zacek (Name of person knowledging) (Name f person ack owledg'Ag) (Signature of N ary Public-State o Florida) (Signature of Notary Public-State of Florida) Personally Known x OR Produced Identification Personally Known x OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No c�JJ �aI CO EEN SULL on No y A COMMISSION#G 71535 '';qd.9,•` EXPIRES February 0 2021 ,o ;. MY IS # G071535 rrlma e ruary 09,2021 Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS