HomeMy WebLinkAboutBuilding Permit Application JUN/05/2015/FRI 12:49 PM ARS Rescue Rooter FAX No, 772-794-9783 P, 001
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: k5 0
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Building Permit Application
Planning and Developmenr Services
Building and Cade Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Mechanical
,
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Address: FJ101tLC�flt7 '�� 2\_CrCc Et_ 3LTq 46
Legal Description: S 03 1_O-k 2 G\1 J L
Property Tax ID##:I\C) • x ok • Ob Lcy •000• �J Lot No.
Site Plan Name: 0_ 1C r,1CA\ f�hZ C,"O-C- Block No.
Project Name: C cA_,r nf \1
Setbacks Front Back: Right Side: Left Side:
Replacing AIC, exact change out, no duct work with "� Lf-nn 0X
14 5151
niona work o e e orme un ert is permit-c ec a appy:
UHVAC U Gas Tank OGas Piping _Shutters Windows/Doors
®Electric L1 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 7-Lo Utilities: Sewer O Septic Building Height:
Name Name: Zacek,Dennis
Address: 44q 60 r)'W 96 — Company: American Residential Services
City: � �C. 9 ifx(.C' State: Address: 2800 US Hwy 1
Zip Code: 3yqxArr)—_ Fax: City: Vero i5each State:FL
Phone No. "12.1 -6 "L - \ 1 Zip Code: 32960 Fax: 772 794-9783
E-Mail: N\Wr Phone No. 772 794-7221
Fill In fee simple Title Holder on next page(if different E-Mai[: bderby@am,com
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.
JUN/05/2015/FRI 12;50 PM ARS Rescue Rooter FAX No. 772-794-9783 P, 002
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DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable,
Name: Name:
Address: Address:
City; State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Name: Name:
Ad d ress: Address:
City; City:
Zip: Phone: _ Zip: Phone:
I certify that no work cr 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 lict 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 1 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,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residentlal 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.
Ctw'—�, -- — s
gnature of Owner/ /Agent SiSpAure of Contractor/Lice older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF at lx COUNTY OF SiL.de _
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisday of .111Y1 _ 20 apy this 5 day of��Uh� .20 by
Dennis ZEcek Dennis Zacek
(Name of person acknowledging} 01arn of person acknowledgin
( re of No ublic to of Florida) (SI re of Notary Public-St a of Florlda)
Personally Known x OR Produced Identification Personally Known x _OR Produced identification
Type of Identification Produced Type of identification Produced
Commission No. FF220930ission No. r1`220931)BETH A DERS - BE H A DERIDY
°"i •': MY COMMISSION#FF 20930 ''' •= MY C M
EXPIRES April 15.7D19 EXPIRES April 15.2010
Revised 07/1.5/2014 werJae's.0•5,3 007p J3 +•b�aed«ayse�noo.com
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