HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 772-770-0064 ARS 15:22:27 10-20-2015 115
ALL APPLICABLE INFO
-�MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / V- IJV' I�� Permit Number: ISJ 0
O �
Building Permit Application OCT 2 0 2015
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
.d._ i .,,:tem �:.t. t..� kf. .,�-.� _ �_..??s�..., ar:� �+x T.z'6,r,a2c •.x>-
Address:-5 33 �DQ1ix-e_ L
X � El Pierce- EL ASIbiy
Legal Description:R0L\&i n0 `Jh,0fK5 — Phage A�Q-. LOk 20$
Property Tax ID#:n1��.' Z.'0\09 .000•�.p Lot No. o?0
Site Plan Name: 'ky,cinck'*
ka t g. 1 Block No,
Project Name: �OoQW 1V 1C�L gCx�11�_
Setbacks Front Back: Right Side: Left Side:
Replacing A/C, exact change out, no duct work with 3 Ton 'Rtine,um 10 lr`vJ
1r7 7 c, l ik Ale blLO e-m
H' - .t r c - �.✓u ..vc.�
Ffl'
s
f
x
-
iteona wor to e e Orme un er t is permit—c ec a appy:
11
HVAC �Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers 11 Generator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 5_7U_°° Utilities:oSeweE Septic Building Height:
C71hlNEf,ESSf ErY ;makr ' '` C017RA�CQRUM
NameName: Zacek,Dennis
Address:553.3 SD?M" `N yZzvZr 9-d Company: American Residential Services
City: irt- r�exc, State:FL Address: 2800 US Hwy 1
Zip Code: 64E51 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 15:24:32 10-20-2015 2/5
ti
IDESIGNER
- -----..y, ,f/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
commmencing�work or recordingour Notice of Commencement.
1J¢r�3a2L -✓e1 s
Signature of Ow er/Lessee/Agent, Signature of Cont or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SL Leee COUNTY OF St Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_YU day of CY*A-i e C 20 rj-by this_L(p day of 0C-W-W-t'�.20 LIS-by
Dennis Zaeek Dennis Zacek
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Sta&of Florida) (Signature of Notary Public-Sta e f Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. FF220930 (!uTH A DER13Y ommission No. FF220930 ' '�: "•83Y
MY COMMISSION#FF2209 •_ MY CO, 'r'A x FF220930
:yril 15.2019 E+ ,t_ ,NprA 15.2019
o.
""" ,, FWnd;Moce75a"+�='^• (407 398A'S3 ��ur:dalloaySe^nce.::M'
Revised 07/15/2014 107'3es 953
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS