HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: .7)\ nP,l fAaC7 `'� -) Vtw-�- ^<4- i ,l 3-AcIta
Legal Description: 1pU
V) c
Property Tax ID #: Lot No.
Site Plan Name: -CABlock No.
Project Name: _f_Gi� ►
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Exact change out of water heater, installed 30 act kkc� EIe.�-C' { C-
�' Xnn 5 `9 er
?c -o � 36 Q.t't� w��r 1nrG�-
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit –check al! apply:
HVAC f] Gas Tank []Gas Piping 1J _ Shutters Q Windows/Doors
Electric Plumbing Sprinklers E Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
CX-5:>
Cost of Construction: $ /0140 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
Name -Ca \ *t
Addre s:
City:State: FL
Zip Code: Fax: N/A
Phone No.
E -Mail: N/A
Fill in fee simple Title Holder on next page [ if different
from the Owner listed above)
CONTRACTOR:
Name: Zacek, Dennis
Company: American Residential Services
Address: 2800 U5 Hwy 1
City: Vero Beach State: FL
Zip Code: 32960
Phone No. 772 794-7221
E -Mail: bderby@ars.com
Fax: 772 794-9783
State or County License: CFC1428283
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: 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 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 your Notice of Commencement.
_ Signature of O er/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF stLuda
The fog ing instr ment w s acknowledge before me
this 1�dayof�(-►X . 211� by
Dennis Zacek
{ e of person acknowledging j
(Signa ure of Notary Public- State of (l cla )
Personally Known x OR Produced Identification
Type of Identification Produced _
.- BETH A DERBY
Commission No. FF22093 I;i� MY C"JhSION p FF220930
EXPIRES April 15 2019
{4C,I304-U'53 • w.m., _ ...
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
Signature Contrar License Halder
STATE OF FLORIDA
COUNTY OF St Lucia
The forgoing instrument was acknowledged before me
this t- day of (-"% � 20 It Q by
Denr:s Zecek
{ e of person owledging j
{sure of Notary Public State f FI rich j
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No. FF2249;3i''yN"
Bl ff&� DERBY
'
MY COMMISSION N FF220930
EXPIRES Aor l 15 2019
FbWaNln.ay5r....,c.a coir
SUPERVISOR I PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW