HomeMy WebLinkAboutBuilding Permit Application JUN/26/2015/FRI 01 : 22 PM ARS Rescue Rooter FAX No, 772-794-9783 P. 001/005
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number. �I
0
_.............................'........_.......
Building Permit Application
Planning and Development Services
Building and Code regulation Division
2300 Virginia Avenue,Fort Pierce FL 34981
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR; Mechanical
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Address: `^1-70 A peny-)W% L.c�_n-r_ 3 14q5
Legal Description: 1 Qu ,Qt�c1�-- Ori 'S;Ly I
Property Tax ID#: Vr tO L00- C)-,jJ 1 ' C ' I Lot No. 1
Site Plan Name: PSV-P_0' CYIa4) k Block No.0
Project Name: n (ICC_� )Q
Setbacks Front Back: Right Side: Left Side:
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Replacing A/C, exact change out, no duct work with 3 'mon
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it�ona wor o e e orme un er t as permit—c ec a appy: ...
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
QElectric ❑Plumbing �5prinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ SRf utilities:l Sewer 11 Septic Building Height:
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Name 'A\`Cy) Name: Zacek,Dennis
Address: �)"10� PcnnU Lc ne— Company: American Residential Services
City: F� ?1'e—fC r, State: L Address: 2800 US Hwy 9
Zip Code: Fax: kl I A City: Vero Beach State:FL
Phone No. 1Zip Code: 32960 Fax: 772 794-9783
E-Mail: N Phone No, 772 794-7221
Fill in fee simple Tltle Holder on next page(if different E-Mail: bderby@ars.com
from the Owner listed above) State or County License: CMC1 249753
If value of tonstructlon Is$2500 or more,a RECORDED Notice of Commencement is required.
1UN/26/2015/FRI 01 . 21 PM ARS Rescue Rooter FAQ No, 772-79G-9783 P. 002/005
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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 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 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,
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.
s
gnature of Owner/—Le e/Agent Sigfiature of Contractor/ ice se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF s1.1-W. COUNTY OF &Ludc
The forgoing instrurnent was acknowledged before me The forgoing instrument was acknowledged before me
thiso2tedayof dxl)C. 20 Lby this day of jvn-e 20 L by
Dennis Zscek banes Zscak
(Name of person acknowledging j (Name of person acknowledging)
(Signature of Notary Public-Stat f lorida) (Signature of Notary Public-State Wicirlda)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. FF220930 ommission No. FFz�o
N A DERBY n;►R` TH DERBY
;? �`' :
MY COMMISSION N 1rF2209 MY CONMISS N#FF720930
EXPIRES ApdI ib,2019 EXPIRES Aptil 15,2019
Revised 07/15/2014 oori 39!U"SJ 4407,39"'53 F eM�*•ro^
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS