HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
- r
NUE
ti= 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
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
CDU�I
Property Tax ID #:
Site Plan Name
Project Name:
L.
Kncbi
x
Lot No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replacing A/C, exact change out, no duct work with r' +Cn 00 ff I e_r,
1 L- . 5 Seer 'Pu rKaye, r+"j G u o rt -
CONSTRUCTION INFORMATION:
Additional work o be erformed under t ispermit— check all ff appy:
aHVAC Gas Tank E]Gas PipingShutters Windows/Doors
_
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �_ Utilities: Sewer EI Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name Q
Name: Zacek, Dennis
Address:.LAD E euia dor V`ic3.V
Company: American Residential Services
City:
Address: 2840 US Hwy 1
Zip Code: 9 Fax:
City: Vero Beach State: FL
Phone No. 't Z
Zip Code: 32960 Fax: 772 7949783
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:
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 vour Notice of Commencement.
s
_ Signature of Ow r/ Lessee/Argent Signature of Cont or/License Holder
STATE OF FLORIDA
COUNTY OF 81.Lude
The fgWing instrme t was acknowledge before me
this day of 20 Wy
Dennis
person acknc
(Sign'aTure of Notary Public- Sfte of Florida j
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No. FF220930
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF $1Lu�
The forgoing ins rument was acknowledged before me
this a day o 20 � t ► by
Dennis Zacek
(Name of person
Notary Public- Statfi kf Florida )
Personally Known x OR Produced Identification
Type of Identification Produced
;eal) BETH A DERECom lssion No.
My COMMISSION 9 FF 2nazn
car
OLTH A DERBY
My CnAhkhle�. . .
EXPIRES APr+1 15 2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS