HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 10:23:23 06-24-2015 1/5
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:C 5 Permit Number:
u REEVED JUIN 2 41
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Mechanical
Pf ON /0MENIN
Address: 1820 t C5,\Aen &n(A fir- FV Pir-4-c'e- F L 3 jq y S
Legal Description: c oJAa Y1 A 9 \k U 9 e-sn
Property Tax ID#: a3���a� �Oa 5 0 06 _5 Lot No.
Site Plan Name: Block No.
Project Name: 1603-d t E�?n n a C
Setbacks Front Back: Right Side: Left Side:
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Replacing A/C,exact change out, no duct work with
Pdp* 0,1 _-�A Tt)t P,
CC3f�ISt�11zOTION #NEORIrRi
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Additional work toe nertormed unclerthis permit-check aill appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑Plumbing ❑Sprinklers ❑Generator ❑Roof
Total Sq, Ft of Construction: Sq.Ft.of First Floor:
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Cost of Construction:$ 4-1CiO—' Utilities: Sewer F]Septic Building Height:
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Name LA)c:.Lx'r_f� E kai a or- Name: Zacek,Dennis
Address: i �20 Cc`�1dQf1 loot-d Company: American Residential Services
City: Fp
1. Pierce-erce, State:,LL Address: 2800 US Hwy 1
Zip Code: '3q_7 q S Fax: 1Il A City: Vero Beach State:FC
Phone No.(-1-71) 4 i-( - e,447 0 Zip Code: 32960 Fax: 772 794-9783
E-Mail: L4 A Phone No. 772 794-7221
Fill In fee simple Title Holder on next page(if different E-Mail: bderby@ars.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. - -- --- - --- - - ---- -
772-770-0064 ARS 10:25:35 06-24-2015 2/5
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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:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in convict 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 ail 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-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.
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s
gnature of Owner ssee/Agent SigoAture of Contractor/,L[gP4se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SLLude COUNTY OF siwda
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this 2,3 day of L)r1-e- 20 L, _by this �n day of Jun-e__ 20 /5 by
Dennis Zacek Dennis Zacek
(Name of person acknowledging)
(Na of person acknowledging)
`+ J
JSlgfdture of Notary Public-Statef F rida) (Signature of Notary Public-Stat in
lorida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. FF220930 fission No. FF22osso
BETH A DERE _��;:��• A DERBY
DAY
0930 1 SIGN a FF220=
EXPIRES Apra 15.2019 %, « EXPIRES Apeit 15.2019
Revised 07/15/2014 ,ea;vei-u's3 Inw4aNmis'...am "3sso�. 3_ "d. wsdyS vC0.=r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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