HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 08:09:29 08-18-2015 1/8
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 x
PERMIT APPLICATION FOR: Mechanical
Address: i✓
Legal Description; -ex S E L C�
Property Tax ID#: E3uI(0 C6 Lot No.
Site Plan Name: Block No.
Project Name �SPS��Iit �� i e.
Setbacks Front Back: Right Side: Left Side:
Replacing A/C, exact change out, no duct work with 2. A G S44tM . U n i }-
v� �u 5t"e-r DC7 1Z\"s V In 2• ZJroto
Additional work to be oertormed under this permit-check all that appy:
QHVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers Genefator Roof
Total Sq.Ft of Construction: S . of First Floor:
Cost of Construction;$ a5g Utilities;]Sewer Septic Building Height:
OIhINER/LESS r 3 � CONTl3ACTQR <
Name ame: Zacek,DeNisn�
Address: G�Oqp ny; Residential Services
City:- State: ddress: 2800 US Hwy 1
Zi Code: /h� 9l^ �(-0� {��1 Cit : Vero Beach State:FL
,Phone No.3fK1 1S oL(_) Zip Code: 32960 Fax: 772 794-9783
E-Mail: 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 08:11:42 08-18-2015 2/8
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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 the permit 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.
_Signature of Owner/Lessee/Agent Signature of Cont etor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF-SI.Lucie COUNTY OF SiLude
The forgoing instr ent was ac nowledged before me The for oing instrument was ack owledged before me
this day of 20 .may this day of 20 115by
Dennis Zacek Dennis Zacek
(Name of person acknowledging} (Name of person acknowledging}
(?��
Z — <�__
(Signature of Notary Public-State of Florida 0 (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
`. BETH A DERE
Commission No. FF220930 •'X� Seal BETH A DERE Com i55ion No. FF220930
( } .(WbOMMISSION A FF2 30
?•i
My COMMISSION 9 FF"20930 %, EXPIRES April 15.201
EXPIRES AX;l 1 42---
NC713D&0'SJ fbrgaNa�ySe.nc�.W'r
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS