HomeMy WebLinkAboutBuilding permit application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: o� O Permit Number: `' /� 6� ` l0
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Building Permit Application
jPlanning and Development Services JUN 23 202-0
Building and Code Regulation DivisionZL
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential°X`�
PERMIT APPLICATION FOR:
Pool inground
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Address: 4205 BURNT FOREST COURT.
Legal Description: HOLIDAY PINES S/D-PHASE III-LOT 476 (MAP 14/07N)(OR3741-1463)
Property Tax ID#: 1313-502-0053-000-1 Lot No. 476
Site Plan Name: Holiday Pines Block No.
Project Name: EMERY
Setbacks Front Back: Right Side: Left Side:
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D,ETA�ILfD DESCRIPTION OF�UI�EORK � � ��- F � 3 � '�' ��+
CONSTRUCTION OF IN GROUND POOL WITH HEATER&CONCRETE PATIO
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Additional work to e e orme- under-this permit—check a appy:
❑HVAC n Gas Tank Gas Piping. _Shutters Windows/Doors
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ElElectric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: SIn
of First Floor:
Cost of Construction:$ �,a� UtilitiesSewer Septic Building Height:
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Name PHILLIP/LORI EMERY Name: JOHN M. MAY
Address: 4205 BURNT FOREST COURT Company: .JM CUSTOM POOLS INC
City: FT. PIERCE State: FL Address: 2503 DYER ROAD
Zip Code: 34951 Fax: City: PORT ST. LUCIE State: FL
Phone No. Zip Code: 34952 Fax:
E-Mail: Phone No. 772-240-3268
Fill in fee simple Title Holder on next page(if different E-Mail: JMPOOLS@BELLSOUTH.NET
from the Owner listed- above) State or.County License: CPC1458456
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not able,
Name: M.RANDALL RODGERS Name:
Address: 1801 HAZELWOOD DRNE Address:
City: FT.PIERCE State: FL City: State:
Zip: Phone: 772-201-1634 Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicabl
Name: Name:
Address: Address: i
City: City:
Zip: Phone: Zip: Phone:
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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 jobsitel
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.
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Signature oftener/Agent/Lessee Sig lature of Contr ctor/Licen older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST.LUCIE COUNTY OF ST.LUCIE
Ther oing instr en as acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 A10 by this L day of 9'a ri;/ ,20_" by �
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(Nam o rs cknow90
g) (Name of person acknowledging)
(Signa ure o of ublic- t to of Florida) (Signature of Notary P Ic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission N
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ion No. Lr� j 3J z�v (Seal)
�r 0. No�ry Public State of Iorida
+R Kaylin J.May ;. •: WILLIAM H DONOVAN JR
< y ornM'3r MY COMMISSION#GG693576
dr Expires 1010312023 ,..
Revised 07/15/2014 °i^ EXPIRES April 12,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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