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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d a -i 2 A Permit Number:
Building Permit Applicatio FEB 2 7
Planning and Development Services
Building and Code Regulation Division I SIT, Lucie County,
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xx
PERMITTYPE: SWIMMING POOL WITH CONCRETE DECK
PROPOSED INPROVEMENT LOCATION:
Address: 9632 FNCi AVF (-.IR(-.LF PORT ST i UCIE
.Property Tax ID #: 3322-800-0012-000-1 Lot
Site Plan Name: MAVRTDEs Block No.
Project Name: MAYRIDFS
DETAILED DESCRIPTION OF WORK: I -
INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 130,790.00
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OW.NERAESSEE:
CONTRACTOR:
Name TWr)mACAmT)mTRTAmmAVRTTIRC
Name: IAmTzgT TR6)ArARr)
Address: 9619 ENCLAVE CIRCLE
Company: A&G CONCRETE POOLS INC
City: PORT ST LUCIE State: FL
Zip Code: 34986 Fax:
Phone No.
Address: 8880 GLADES CUTOFF RD
City: PORT ST LUCIE State: FL
Zip Code: -34986 Fax:
Phone No 772-878-7752
E-Mail:
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
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E-Mail : �V I �.2 O O Qn� pw s. I' U,-,�
State or County License CPC1457902
•a.-= z cails ..00011 .a pcavu ", ,"ore, a.,cu.ueueu nonce oT commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Y
MORTGAGE COMPANY: Not Applicable
_
Name:
Addr ss 7 2
Address:
City: V I, State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING. COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation indicated.
as
I certify that no work or installation has commenced prior to the Issuance of a permit.
which Is inconfi. tawithanyapplicablelHomeOwnersPsssopatlon1rulesabylawsorandcovenantsthatmatyrestrctorprohibitsuch
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration of the granting of this requested permit I do hereby agree that 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 our Notice of Commencement.
r
Signature of Owner/ Lessee/Can act as Agent for Owner
Sign a of ractor/License Hold r
STATE OF
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LUCI R
STATE OF
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thisl_dayof�20�by
The forgoing instrument was acknowledged before me
this day of 2 by
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Name of person. making statement.
Personally Known OR Produced Identification
Name of person ma�kinn tatement.
Type of IdeofjEati l(s (; /n n C,
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Personally Known V OR Produced Identification
Type of Identification
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REVIEWS FRONT ZONINGSUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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