HomeMy WebLinkAboutBuilding Permit Application 772-770-0064 ARS 10:46:07 12-21-2015 1i6
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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.
Vr`�.- y`M�
Address: i 625Mr0 620 e '7 L L ( }
,dJ
Legal Description: .z
ZU
O r T-V%? ase'.
Property Tax ID#: _ '� 7C5`� (}(`)° 14 — LotNo.
Site Plan Name:__-t__ SSS+(s Block No.
Project Name: �,i
Setbacks Front ( Back: Right Side: Left Side:
? .� }1�, '"
r1:T �,,.a mss" _ `"' ,,` s' '�'"w.ia<R�, ��` '}+.34'- ,:e „+' zr'>-` •+.� `st
k:.c.. ,cr .::-�'" x,.:.�.+ x
Replacing A/C,exact change out, no duct work with iohs P J iee_ rn t10 KVJ Spl,+ Rk SC/S4 'll
A(la
-....._. .�r.-.,� T s �'.'., _ _:.._.X+.._ :,.? � �'r��..�.,, S�"5....y✓:�,.,�'��ay.`.,,h`�`��w,..c'+.,•...a.-. �-:�o..n�;}� k4,r`....,;:4,a�i...:a.�
itiona wor to e e orme under this permit—check all that appy:
,,HVAC Gas Tank Deas Piping _Shutters Q Windows/Doors
OEiectric 0 Plumbing ]Sprinklers []Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ ) r C � Utilities: SewerSeptic Building Height:
MR.€k
Name t"a I_r rip's Name: Zacek,Dennis
Address: {r . ' ! Company: American Residential Services
City: Lucie, State:�7—L Address: 2800 US Hwy 1
Zip Code:Flo Fax: City: Vero Beach State:FL
Phone Na 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 10:48:39 12-21-2015 2/6
r:= •.5E'r�'-e^ "S t�t'ci� G�`,y
>f
11
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.
-Signature of Owner/Lessee/Agent . '` Signature of Contr or/license Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St.Lucie COUNTY OF Sii.eae
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of b-ei-, 20 1f�by this�day of _Dfc--•e ie20 /n by
Dennis Zacek Dennis Zacek
(Name of person acknowledging) (Name of person acknowledging)
C-7 Il; � ,,—
(Signature of Notary Public tate of Florida) (Signature of Notary Public-Statebf Florida)
Personally Known x r Personally Known X OR Produced Identification
Type of identification Prod CO BETH A nFRRY I 1pe of Identification Pr
MY COMMISSION a FF2209 0 BETH��tt�1A DERBY
Commission No. FF2z0990 ';•, ( mmission No. FFzzos d•. MY COI ISSION FF2T0930
iRES April 15,2019 ,
1467)398.0.53 fbridaNw�ryservita.carr o.o::�, EXPIRES April 15.2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS