HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 15:06:33 08-31-2015 1/5
ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -
Date: ✓ _� Permit Number: '1501 --O
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F134982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
Address: l
Legal Description: Qct ion "'-'Mores
Property Tax ID#: \,, 2- ' 51y L nm!5 -�l Jas '--0 Lot No. �
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Site Plan Name: S ��1M i�T, 10-) Block No.
Project Name: m --
Setbacks Front Back: Right Side: Left Side:
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Replacing A/C, exact change out, no duct work with TOY) &CC
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itiona wor to e e orme x un er t is permit-c ec a appy:
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HVAC Gas Tank ❑Gas Piping Shutters a Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: ' SQ.Ft.of First Floor:
Cost of Construction:$__ Utilities:Dewer 0Se tic Building Height:
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Name Name: Zacek,Dennis
Address: a ( 0 mpany. American Residential Services
City: S e:EL Address: 2800 US Hwy 1
Zip Code: Z) Fax: City: Vero Beach State:FL
Phone No. Zip Code: 32960 Fax: 772 794-9783
E-Mail: Phone No. 772 794-7221
Fill in fee simple Title Halder 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 15:08:53 08-31-2015 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 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.
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_Signature of Owner/Lessee/Agent Signature of Contraefor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF st.L-e COUNTY OF siwaa
The forgoing*nstr ment was a nowledged before me The forgoing instrument was acknowledged before me
this; day of 20 L,by this day of _,20 by
Dennis Zacek Dennis Zacek
(Na rson ack d Ing) (Name of person acknowledging)
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(Signature of Notary Public-State ofor' a) (signature of Notary Public-Stat of lorida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced ype of Identification Pro
Commission No. FF220930 :� , MY ��S�D FF2204 ommission No. FF220930 .� t'= MY q SSION N FF220930
EXPIRES April 15.2019
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EXPIRES April 15,2019
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o07/3950'S
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS