HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 10:36:24 12-21-2015 1/5
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED yn�
Date: Permit Number:
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Building Permit Application
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
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Address: �.J IIS X2 1. l -- 'i .�rio FL j�L1 CI S 1
Legal Description: S .Y��t � I f'_C Et71 m*ys.� C_l uby i l t c1 GA
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Property Tax ID#: Lot No.
Site Plan Name: eE G Y 0 Block No.
Project Name: n-k+)
Setbacks Front Back: Right Side: Left Side:
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Replacing A/C, exact change out, no duct work with LA S-c.l-c-- r
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Additionalwork to be erformeci under this permit-check all that appy:
HVAC L�1 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers o Generator Roof
Total Sq. Ft of Construction: Sq•Ft.of First Floor:
Cost of Construction:$ LCaw Utilities:[]Sewer aseptic Building Height:
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Name Name: Zacek,Dennis
Address:'`) C G Ca Company: American Residential Services
City: J -4 :rC 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 10:38:39 12-21-2015 2/5
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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,l 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.
_Signature of Owner/Lessee/Agent Signature of Cont or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SL Lucie COUNTY OF St Luce
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofCC''i '1✓ 20y this day of 1 're.YYI bcr.20 lc:-)by
Dennis Zacek Dennis Zacek
(Name of person acknowledging) (Name of person acknowledging)
62
(Signature of Notary Public-StateW Florida) (Signature of Notary Public-State of FI-4'Na)
Personally Known x OR Produced Identification Personally Known x OR" ntification
Type of Identification Produ a yT e of Identification Produced,• W&
FF220930 �= 11( CMISSION p FF220 3� FFzzosso =;.
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Commission No. ffa mmission No. ?aM1e o
� EX IRE$April 15.2019 PIKES April 15.201
t407t398-0'53 ftpndiNoarySernce.:ar Fa+roalloaySemce.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS