HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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R.
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: _,:2 ID yj E6f_ 1— 3 LAq q
Legal Description: -larsD -7a � 1 9 tYle5
Property Tax ID #: 14 -aj 2-10 - COO?) - 000
Site Plan Name:Sx-�b(�
Project Name: cf-ck kocOr c,• , ^TbYYI
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
R�
Lot No.
Block No.
Replacing A1C, exact change out, no duct work with 3, 5 +Q) r1 Ccz,rr'ii (ff r -
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit —check all apply:
0HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $_5`485 °O Utilities:Sewer Septic Building Height-
OWNER/LESSEE:
Name i,rni,,,34p,:,f-'cl , "ThM
Address: R in W IF V -i f l +r
City:jar-�- Pt pahGe_State:
Zip Code:,ng L4 (2 Fax:
u
Phone No. t6_0 RO'��-%
E -Mail:
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 US 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: 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 County makes no representation that is granting a ermit will authorize the permit holder to build the subject structure
which is -in conflict with any applicable Home Owners Association rules, bylaws or ana covenants that -may restrict or prohlbit 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.
n
Signature of 0wer/Lessee/Ape rt
STATE OF FLORIDA
COUNTY OF St. Lucie
The for oing instrument was acknowledged before me
this day of 2014by
Dennis Zacek Dennis Zscek
Z(urepers owle ging ) of Nota u lic- tate Florida }
cation �,,,�„
OF) # FF220930
pri! 15 2019
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SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
Signature of Cont oor/Uccense Holder
STATE OF FLORIDA
COUNTY OF S1 Lucie
The for Ding instrument was acknowledged before me
this � day of r)r _- 20 �by
Personally Known x OR �ifuced Identifl
Type of Identificationtl
�tG�n
Commission No. FF220B3Q- I��° COA�tvallI
EXPIRES A
e�nn Goya
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
e of person ac wledging }
tore of NotarDERBY y Pu !c- State of or! a }
Personally known X OR Produced Identification
Type of Identificatlon'Prpdu4rJ
BETH A Q
ERBY
Commission No. Fi=zza93o�''; MY Con�M(rSSiti}� a FF22tl93o
EXPIRES Aprt! 15, 20'!9
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