HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
k
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:--
_ Legal Description:
Property Tax ID ##: - '~I Lot No. I r1
Site Plan Name: _ .1�nr.lt (p.1 --V-► r ) Block No. �
Project Name: f;]P�-1n r Y P,1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replacing A/C, exact change out, no duct work with 5, 5 +on vzhee m
1 y Sect .-1 K Ur} 50 1-\_ A [ C 5_45-�-Cm
I CONSTRUCTION INFORMATION:
Additional work to bnGasTank
rtormed under this permit- check all apply:
HVAC ❑Gas Piping In Shutters Windows/Doors
Electric 0 Plumbing []Sprinklers E Generator Roof
Total Sq. Ft of Construction: ' S Ft. of First Floor:
Cost of Construction: $ ��` -i Utilities:]Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name-2ev-1 +r1 r- -T—k rYl Name: Zacek, Dennis
Address: �QjjftD 1 ,r Company: American Residential Services
City: F-�- QJf G`�, State: L Address: 2800 US Hwy 1
Zip Code: Fax: City: Vero Beach State: FI -
Phone No. f -171t �Z �' Z_Zt 5 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 !AW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY:
Name: Name:
Address: Address:
City: State: City:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY:
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.
J
J
x Not Applicable
State:
x Not Applicable
St. Lucie County makes no representation that is granting"ermit will authorize the. ermitholder to. build the -subject -structure
which is in conflict with any applicable Home Owners Assoc+atiari 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 Ow err/ Les ee/Agent
STATE OF FLORIDA
COUNTY OF St. Lucie
The for oing instpm— t was acknowledge efore me
this ay of ( T 20 Wy
Dennis Zecak
Signature of Cont or/Licerise Holder
STATE OF FLORIDA
COUNTY OF stLucie
The forgoing instrument was acknowledg d before me
'.-1'
this 41 day of� .2j Q_ by
Dennis Zacek
(N a of person acknowledging ame of person acknowledging
i
(Signature of Nota ublic- State For a j ignature of Nublic- Sta o Flc
Personally Known x OR Pro Identification Personally Known X OR odu ei
Type of Identification P. .L-;�z,,�. Type of Identification Produced_
Commission No. FF220930 746 . MY(6*i+5 QDERB NN 20g�Commission No. FF220e30
EXPIRES April fir.:
�:+
' q i5, 2019
rarwu, tom
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
SUPERVISOR PLANS
REVIEW REVIEW
Identification
(SeWTN A DERBY
MY CoklM1SSiON Ai FF22o9;.
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VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW