HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
-k. J
•
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
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Lot No.
Site Plan Name: C�N�oorn, Block No.
Project Name: ( _0 \I20r'1 , C ,,j
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
Replacing A/C, exact change out, no duct work with Ton L_c_n )oX l (p
seems' o VV J SP
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit — CheCk Checkall tbat appy:
HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
U Electric ❑ Plumbing 0 Sprinklers 1:1 Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $ (n ( a F:SD
bU
S Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C.Okh-rn , C-J-ey*e'! 4- -
Name: Zacek, Dennis
Address: t O U U f\Q IC:e_ 9_ _ CuL4,1'e•
Company: American Residential Services
City: Pi, 40ccf-, State: jF='S _
Address: 2800 US Hwy 1
Zip Code: q Fax:
City: Vero Beach State: FL
Phone No.—n2— y (RLP - o%T�S
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
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.
1n 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 Ow r/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF sl Lode
the farp,Qing instrument was acknowledged before me
this' day of MQL rr �n 20 ,1>y
Dermis Zacek _
(Name of person acknowledging) -
r
'" (--F� '� . � IQ— - — —
Ki g --nature of No ry Pub is ate of Florida }
Personally Known x
Type of Identification P
Commission No. FF220930
Revised 07/15/2014
OR Produced Identification
�.JeJ1�+e.+► �� 5
Signature of Cont or/License Holder
STATE OF FLORIDA
COUNTY OF SIL -ie
The forgoing instrument was acknowledged before me
this Q5 day of 20 ±LS>y
Dennis Zacek
(Name of person acknowledging j
�� �D' P
(Signature of Notary Public- State of rida j
Personally Known x
Type of identification Prod
No. FF220930
OR Produced Identification
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS