HomeMy WebLinkAboutBuilding Permit Application '772-770-0064 ARS 08:55:59 11-18-2015 1/5
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: Permit Number: C 2A
•
RECEIVED
Building Permit Application OV 9 a ?PJ15
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
Address: al OQ /, C-r li—V-A .�jq L.,.C6ne-, PA C"iev� EL._ J"lQM
Legal Description:7 f- QA14 A e
Property Tax ID#:a�Aos'sol `Data.(�(n t Se Lot No. t
Site Pian Name:%L, doss -, Licorarf, Block No.
Project Name:„�A„}[l\, s�k l� L_e ward
Setbacks Front Back: Right Side: Left Side:
k ' A1 ESC
Replacing AIC, exact change out, no duct work with .) -Tbn P'VYC-P_rn 1 LA �jFf-e-''
k{rr ,rE.+. „y '�'r `^'
itiona work to e e orme un er t is permit-check a apply:
0HVAC U-Gas Tank ❑Gas Piping nGenerator
Shutters F]Windows/Doors
Electric 0 Plumbing Sprinklers Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$
_U a�Q`Q 2 Utilities:11Sewer Septic Building Height:
G y r. ,r"'3' far�`"r�- - r'�t 3�' °v9 r TxE�f.u, t.2!`e\
- "NaName: Zacek,Dennis
Address:o2( 0'R at�QW T_jt,..,,C.,An'e.. Company: American Residential Services
City:��"' gjerCAe, State: Address: 2840 US Hwy 3
Zip Code: 349'�i 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.
772-770-0054 ARS 08:58:20 11-18-2015 215'
tr4'w,
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 recording our Notice of Commencement,
''`` r
_Signature of Owner/Lessee/Agent Signature of Cont orf License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St.Lede COUNTY OF SILude
The forgoing instru e t was acknowledged before me The forgoing/instrument was acknowledged before me
this ff da of V1_r 20 b this 4Z da of NiftP Y\beC 20 b
Dennis Zack Dennis Zacek
(Name of person acknowledging) {Name of person acknowledging)
1
(Signature of Notary Publi tate of Florida) (Signature of Notary Public-State Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of identification Produc d "�AlY y of Identification Pro du
y M MISSION a FF22 'f' BETt'1 A DERBY
Commission No, FF220930 ;r�, � Ea mission No. FF220930 r. M,f �
EXPIRES April 15,201 r� MISSION#.201g 3
EXPIRES April M5,2 1
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WaMc;apSerr .
Revised 07/15/2014
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