HomeMy WebLinkAboutBUILDING PERMIT APPALL APPLICABLE
Date:
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Develo ment Services
Building and Code R ulation Division
2300 Virginia Avenu Fort Pierce FL 34982
Phone: (772) 462- 53 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLI TION FOR: Pool inground
Address: --)'L
Legal Description:
Property Tax I D #:
Site Plan Name:
Project Name:
Setbacks Front
Installation of
I]HVAC
ZElectric
Total Sq. Ft of
Cost of Constr
Back: Right Side:%� 1 Left Side:
Pool, Deck and Equipment
iwnucu uuuv urn pcnnu—a.nc�n m� appry:
Gas Tank DGas Piping _ Shutters
Plumbing Sprinklers Generator
$ 3 i_p,15D
SFt. of First Floor: _
Utilities:n Sewer E]Septic
Lot No. "l to L
Block No.
QWindows/Doors
Roof
Building Height:
Vw $�`_ _
_ < 3i'3 ✓' 3fi n, i.
1 V s. 3•P4�'�
Name
Name: Terry V%hx
_
Address: 5L4
14An,
Company: Pools by Greg, Inc.
City: k4' 1
Zip Code: J 5 1
Phone No. v�
State:—
Fax:
yQ3
Address: 8886 S Federal HWy
City: Port St Lucie
Zip Code: 34952 Fax: 772-337-9287
Phone No. 772-337-9713
State: FL
E -Mail:
Fill in fee simpleTitle Holder on next page (if different
from the Owner listed above)
E -Mail: office@poolsbygreginc.com
State or County License: CPC1458338
n varve or construcuol is yZWU or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
LSignature
DESIGNER/ENGINEER:Not
Name: M.RnNoa�lROGERsName:
Applicable
MORTGAGE COMPANY:Not
Applicable
Address:,, RnzElw000DRIVEAddress:
� ��a'PThe
foDing instruant was acknowledgbefore me
The foDing instrumntwas acknowledged before me
City:FORT PIERCE
Zip:349a2Phone7*�-�+-tas^Zip:
State:F�
City:
Phone:
State:
FEE SIMPLE TITLE HOLDER:Not
Name:
Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of IdentificatiorfProduced
Address:
Produced
City:
City:
(Signature of Notary Public- State of Florida)
Zip: Phone:
Commission No. (Seal)
Zip:Phone:
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencin work or recordingour Notice of Commencement.
D
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y+ Ndary Publ c State of Flo 0ays Notary PubIIC Stale of Florida A Thontasina Bowins
+P A Thomasina Bowins +�� My Commiss GG 201733
My Commission GG 201733 @ Expires 03!29/2022
Expires 03129@022
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
LSignature
DESIGNER/ENGINEER:Not
Name: M.RnNoa�lROGERsName:
Applicable
MORTGAGE COMPANY:Not
Applicable
Address:,, RnzElw000DRIVEAddress:
� ��a'PThe
foDing instruant was acknowledgbefore me
The foDing instrumntwas acknowledged before me
City:FORT PIERCE
Zip:349a2Phone7*�-�+-tas^Zip:
State:F�
City:
Phone:
State:
FEE SIMPLE TITLE HOLDER:Not
Name:
Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of IdentificatiorfProduced
Address:
Produced
City:
City:
(Signature of Notary Public- State of Florida)
Zip: Phone:
Commission No. (Seal)
Zip:Phone:
FRONT
LIS
LSignature
of 9er/Lesse/Contractor as Agent for Owner
Signature oftractor/Liansa Holder
STATE OF FLOR14ASTATE
OF FLORIDA
COUNTY OF5'(W(_\eCOUNTYOF
� ��a'PThe
foDing instruant was acknowledgbefore me
The foDing instrumntwas acknowledged before me
this�dayof��by
this�day of��20�y
rERrtr Nnx
rERRv wlx
Nameofpersonmakingstatement.Nameofpersonmakingstatement.
Personally Known � OR Produced Identification
Personally KnownOR Produced Identification
Type of Identification
Type of IdentificatiorfProduced
Produced
(Signature of Notary Public- State of Florida )
(Signature of Notary Public- State of Florida)
CommissionNo.(Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
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