HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 08:26:41 12-15-2015 1/6
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater 6 ' 15 Permit Number:
- q � ,.ijalu RECEIVE®
Building Permit Application
DEC 16 2015
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. L cieXCounty, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residentia`�
PERMIT APPLICATION FOR: Mechanical
Address:
Legal Description: 0 O'D 2io-
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Property Tax ID#:-339-1 ' loot - C5b\g (BOOff�) -- _____ Lot No.—
Site Plan Name: Cam ^n P'k1 G Block No.
Project Name: �M O C#Ylf 11 C1 V)brnen t G --
Setbacks Front Back: Right Side: Left Side:
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Replacing A/C, exact change out, no duct work with q -rone
10 y4j 5p1i�- ��� ��5'em AIM l,6 -rUn I2h�crn 1lv
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work to e e Orme un er t is permit-c ec a app y: -
SHVAC 11 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric F j Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$�� 1 Utilities: Sewer Septic Building Height:
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1. r ON..
Name nt'1P_�Q 1eh► C.. Name: Zacek,Dennis
Address• l� 21 Company: American Residential Services
City: qjpr�r L_kCa e State:L Address: 2800 US Hwy 1
Zip Code: ?y-aq$ o 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 08:29:14 12-15-2015 2/6
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 Count 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 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. 1
Signature of Ow r/Lessee/Agent Signature of Cont or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St.Luda COUNTY OF StL—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-ffa day of nffeo'ber, 20 i6by this AU day of �CrY 1�2p 1 by
Dennis Zacek Dennis Zacek
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Stat a Florida) isignature of Notary Public-Stat o Florida)
Personally Known x OR Produced Identifica" onally Known x u
Type of Identification Praduc .... _DERBY Ty of Identification Pradu BETH A DERBY
— (yMM1SSK3N M FF22 MY COMMISSION q FF22093
Commission No. FF220930 �a� t 15 20 Co mission No. FF22osao -.,. "1110ES April 15,2019
EkPiRES ADn 4aar, a o s3 i
CbWaMa 9M�a'� iOt�QtjYSernta awr
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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