HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
D2te:-7/1(011 q SCANNED Permit Number:
0...o SCANNED
BY
St. Lucie Cot➢ntiv
Building Permit Application
Planning and Development Services
Building and Code. Regulation Division
2300 Virginia 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
Legal
Property Tax ID #: - L Lot No.
�Q Site Plan Name: _ rnq o Lu 1 (� f _ Black No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace AC, exact change out with 3 ton, 4SEER,10 KW AC unit LOAC WaK
I CONSTRUCTION INFORMATION: 111
HVAC Gas Tank
❑Gas Piping
_ Shutters
❑ Windows/Doors
Electric 0 Plumbing
Sprinklers
1:1 Generator
0 Roof = Roof pitch
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction: $ I 1 lJ1tl Utilities:OSewer OSeptic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name
Name: Dennis Zacek
Address:
Company: ARS American Residential Services
City: Stater
Zip Code:' Fax:
Phone No. '-
E-Mail:
Address: 2800 US Hwy 1
City: Vero Beach State: FL
Zip Code: 32960 Fax:
Phone aQ)3
E-Mail: Cs"Mr QI&V NCS - C O'CA
Fill in fee simple Title Holder an next page { if different
from the Owner listed above)
State or County License: CMC1249753
If value of construction Is 52500 or more, a RECORDED Notice of Commencement Is required.
LAWtj
utbl U1VtR/1:1V Glwttlt: x NOt Applicable
Name:
Address:
City: State:
Zip: Phone:
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 Nat Applicable
Name:
Address:
City:
Zip: Phone:
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 the permit holder to build the subject structure
which is in con rct 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,
accessary 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
_ Signature of O� er/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF sms
The r oing ins ant was acknowledg fore me
this day of �i ( 20 I
Da h Zacek
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No (Seal)
COLEEN SU
Revised 07/15/2014
Signature of Contra r/License Holder
STATE OF FLORIDA
COUNTY OF 511.
The to
ins t was acknowledg/e efore me
this o day of=�20 f-4by
Dennis Zacek
(Name of erson ackn ledging
(Signature of Noa blic- State orFlorida I
Personally Known x OR Produced Identification
Commission
EXPIRES February 09, 2021
COLEEN SULLIVAN
EXPIRES February 09. 2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS