HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 08:12:33 09-17-2015 1/5
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O Permit Number: 5�� oa°►3
RECEIVED SEP 17 2015
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
PERMIT APPLICATION FOR: Mechanical
PROPt7SD1MPR0UENIENT L?oc°aTIrN� `{ 7 u _
r
f .Y`
x.y
Address: +1
Legal Description: U '51-kQ
xA0 <-ori \1W o�r O Scc. UYon lam`.
PropertyTaxll) #: 1406 - 'AQ (7DO2' D(QD ' 2, Lot No.
Site Plan Name: mcA)'t Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Replacing A/C, exact change out, no duct work with A -Von
o Y_VJ Cb \tA W C C-11 Sir-r-m .
-
-Additional work toe ertormed under this permit-cneCK all thatappy:
HVAC Gas Tank aGas Piping _.Shutters Q Windows/Doors
11 Electric ElPlumbing Sprinklers 1:1 Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 5�Q 0 Utilities:11 Sewer 0 Septic Building Height:
�OVIINER/LESSEE ` '` "CO�ITRACTORt• � _
-
Name Name: Zacek,Dennis
Address: \1306 in Company: American Residential Services
City:r� x State:11 Address: 2800 US Hwy 1
Zip Code: ?3a Fax: City: Vero Beach State:FL
Phone No. Zip Code: 32960 Fax: 772 794-9783
E-Mail: Phone No. 772794-7221
Fill in fee simple Title bolder 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 08:14:46 09-17-2015 2/5
UP 1 T GOMIS 1 �TIi �[. 1 � lillfi �( R�1%073 N�yX f} Y 3 ,
N N y.'1 ) 1 Y
,..,...� k �'� �� •a^"'.'..-q�J: �: .�-�. :zd..�,`i ...., .+n�'2' r.�c✓ "Nit,
}} i_ !' s `f 3
DESIGNERJENGINEER: 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 apermit 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.
I s
_Signature of Owner/Lessee/Agent Signature of Cont or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF si.i..ae COUNTY OF 5«me
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_L1 day of 20 tiby this_0 day of 20 by
Dennis Zacek Dennis Zacek
(Name of person acknowledging) (Name of person acknowledging)
C �
(Signature of Notary Public-St t of Florida) (Signature of Notary Public-State o lorida)
Personally Known x OR Produced Identificati Personally Known x 0
Type of Identification qd ""'~�,ET!wn Type of Identification Produc :�: ''•. TN ABY
;pw"`•"5t� :•? MY COMMISSION 11 FF2209
S10N d FF220930 Commission No.
Commission No. FF220 •e MY CO "SJ FF220930 (WIRES April 15.2019
15.2019
EXPIRE; 19CT139S0's3 � �
AM
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
_INITIALS-.......... . ......- _....__....__..._................_.............................._...-_...................................._ - _._._..................,_...........__..