HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 09:26:05 10-19-2015 1/5
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
E.< .... RECEIVED OCT 191015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue,Fort Pierce FL 34981
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
P,�ROPOSED iI�TPROUf �NT LOCgT1�31V �� £� `�Y r �F� '
Address: j -1 4` Emaxn t in C'\' . J :A- ,'Q te(e, -1;7 L ,. 3 uccibl
Legal Description: owo �a�CJle.
Property Tax ID#: ,3�6 r 00� 1400 —a Lot No. 4
Site Plan Name:' t(NOEGS f U2 Block No. i.D
Project Name: vilinJ re"()
Setbacks Front Back: Right Side: Left Side:
Replacing A/C,exact change out, no duct work with -701x\ �� C) �Vv
1 y 'Seey- �c�c-li�o►�� Uln li-k--
C� S`IiIJOI )NF�7RN(AION �, ° , Y r`
itlona wor to e e Orme under this permit-c ec a appy:
E1HVAC 11 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers Generator Roof
"total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ —1 1 k'1 Utilities:OSewer OSeptic. Building Height:
Name SJ W Name: Zacek,Dennis
Address: C n �� Company: American Residential Services
City: State: L_ Address: 2800 US Hwy 1
Zip Code: 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 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 09;28;03 10-19-2015 2/5
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 recordingour Notice of Commencement.
�4 t+�rnry ►)e1V__% s
Signature of Owner/Lessee/Agent Signature of Cont or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St•LuUe COUNTY OF S«eGe
The folgoing instr ent w s acknowledged before me The forgoing instrument as acknowledged before me
this day of V --' 20 Eby this-t+-C-.+day of 20 _6by
Dennis Zacek Dennis Zacek
(Na erson ack ledging) / (Name of person acknowledging
l
(Sig otary Public-State of Flori (Signature of Notary Public-Stat Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produce f Identification Proi ur1PA1'.
Commission No. FFz2os3o 'A. '(NXIPOMMISSION 9 FF 2Q ission No. FF220930 MY CENWSION A FF220930
EXPIRES April 15.2 19 .'••„p.,,, EXPIRES April 15,2019
10709 ' IRe)139E•0'S3 flnrfddlWa ernce.caR.
Ie0��J96-0.53 F4rie ute.cm
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS