HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 08:11:03 12-08-2015 1/5
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r Permit Number: I 12:
• Le R"E CEV `l' Com.DU
Building Permit Application
Planning and Development Services DEC 0 8' 2015
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 Lugie County, FL
Phone:(772)462-1553 Fax: (772)462-1578 Commercial ResidentiA .
PERMIT APPLICATION FOR: Mechanical
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Legal Description: IPM *-\-\e
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Property Tax ID#:3291'15b?)DID14 - 0Q0-.-S Lot No. 11R'9
Site Plan Name: "71c' ce'\V E-iC{r L}, Block No.
Project Name: Si U(-e'k 1 ti Gl -
Setbacks Front Back: Right Side: Left Side:
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Replacing A/C; exact change out, no duct work with '-Ton �t��!'�;�CY'► � t �S7
Seer to 'K\rJ SO NobL S -E..
rr• _ � 3r �x Ss K 1 aa''J r�,x� "r t�;.MiJ�4_�.,n �R{�cr .� xrr�s.��Y..�..�?... �$......-, �..o,..
itiona wor to (e�e orme un ert ispermit-c ec a appy:
�_HVAC L_J Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing L.]Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 4, CQ Utilities: Sewer Septic Building Height:
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Name Heir u Name: Zacek,Dennis
Address: ML- Company: American Residential Services
City: P-4)i7 mn IJIState:f Address: 2800 US Hwy 1
Zip Code: I r ( () 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 08:13:19 12-08-2015 2/5
µDESIGNER/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:
ity: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 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 1 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.
Signature of Owner/LesseeJAgertt. Signature of ContrWor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St.Lucie COUNTY OF si tude
The forgoing,ins ent was.�a.c,tk,n�o,,w.,l�.edged before me The forgoing instrument was acknowledged before me
this day of� G� 20by this day of20 _Eby
Dennis Zacek Dennis Zack
(Name of person acknowledging) (Name of person acknowledging)
(1, �Dzo
(Signature of Notary Public- t to of Florida) (Signature of Notary Public-Stat f Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Pro ype of Identification Pro
_ys"'pry: BETH A DERBY SETH A DERBY
Commission No, FF220930 ,, •�; FF220930 `�, �.'
MY l fiSStt3N#FF22093 ommission No. MY{ MASSION#FF220930
,1a
EXPIRES Aprd 15,2019 '•', a EXPIRES April 15,2019
r•
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS