HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 10:31:12 10-27-2015 1/5
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I u�y "(J`►oL"1
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Buitd Permit Application
Building rmit pp
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
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Legal Description: k`on\ck �Xrt6S L-z� H U V. B i Lo C, 2.ane
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Property Tax ID#: 2 yC(1, Lot No. t-"'3 •• r
Site Plan Name: �{{1e '1 U Block Noss-��
Project Name: CL' LhvrC,h
Setbacks Front Back: Right Side: Left Side:
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Replacing A/C, exact change out, no duct work with -To ”
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itional work t0e nertormed under tispermit-check all thar appy:
F]HVAC Gas Tank E]Gas Piping _Shutters F]Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
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Name At`x -1e Cyi"�'�'l C UY-C y) Name: Zacek,Dennis
Address: 1v�D5 N � 1 Company: American Residential Services
City: �f` ' C, _State: C—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 10:33:18 10-27-2015 2/5
W.., 3• ,'! .,e.'��y"'.:tFf .rl� r� .�:
OF 'LEIVlENT I ,N TRUC IOW,41. �rAw MEM vont; W 5 x
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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 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.
V2-r-11
_Signature of Owner/Lessee/Agent Signature of Contr or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St.Ludo COUNTY OF siLuaa
The forgoing instrument was acknowledged before me The forgoing instrument w s acknowledged before me
this�Spday of Cir Vc 20. y thispday of 20 by
Dennis Zacek Dennis Zacek
(Name of person acknowledging) (Name of person acknow )
( i ature of Notary Public-Sta e o Florida) (Signature of Notary ublic- tat of Florida)
Personally Known x OR Produced Identification Personally Known x
Type of Identification Pro uc ype of Identification Produ dam '~Yi BETH A pERBY
BETHMY COMMISS
MY � ION t1 FF2208
Commission Ni
FF22093D �= ISSION 0 FF220s FF220930 y , April 15,2019
. ommission No.
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�a XPI ES Aprd 15,2018 . L1407;1`18,0'53
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iAD71393-0'SJ FariWMwaYsmvic�mc
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS