HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
i
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: l' ])CR r`i'Znr^7 CA 4,4-P.
Legal Description: b?o'n'sh Lcke fin, r \AIW
Property tax ID #: n 19 5;)0 1 Lot No.
Site Plan Name:1Rhl1 Block No.
Project Name: cY�[1 Y1(� i 7 1 Y1 CZP P
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replacing AIC, exact change out, no duct work with kA - -on C QC r t avr I XA
CONSTRUCTION INFORMATION: I
Additional work to b errormea unser this permit —check all appiy: {
❑HVAC [] Gas Tank ❑Gas Piping In Shutters ❑ Windows/Doors L
11 Electric El Piumbing ❑Sprinklers 1l Generator � Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ lir 2;? LQ CID Utilities:'nSewer ❑ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name C!'�r1rn �Z� �1 Name: Zacak, Dennis
Address: -0-A 6�)\ mo r ZCL1 rA �i �,. Company: American Residential Services
city:rte` Pl e -� State: _EL. Address: 2800 US Hwy 1
Zip Code: _3 LA Ci�� GFax: City: Vero Beach State: FL
Phone No. _�77 UFSQ � `, r7 Zip Cade: 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 GONSTRUCTION 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 TITLEHOLDER: 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 Commgncement.
_
_ Signature of Ow 5rle/Agent
STATE OF FLORIDA
COUNTY OF st.L we
The forgoing instrmnt w s ack nolyv edgere me
this day of
Dennis Zook
Signature of Cont or/License Holder
STATE OF FLORIDA
COUNTY OF stUde
The fiygoing ins ment was cknowledged efore me
this day of 20 JWby
Dennis Zmmk
1(5�gture
person acknow45tat
Za
of person acknowled ing j
of Notary PuFlorida)ture of Notary Public Stat of F orida )
Personally Known x OR Produced Identification Personally Known x --@t1 '1\ dentifieatia::
-r'^•' BETH A DERBY
Type of Identification Pi oqy . T s issav Type of Identification �cpt�
y'c MY C 1M 510N # FF22093U : = MY COMMISSION # FF220930
Commission No. FF22093 1:,•. Commission No. FF22 i EXPII�alanl i5 2019
;1 EX i Apel 15.2019 •I1"l:
cr'ri.a l'7, 3'1'S-U'S3 FinrMaNaaryS;rrP
7 FWxlano�a�jSr•:xe:cm
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS