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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 09/10/2020 Permit Number:
,T
L ' " ` --:_ Building pp Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: (,bpL VjGAI- a- e-1jT
Address: 902 ELYSE CIR PORT ST LUCIE, FL
Property Tax ID #: 3416-801-0022-000-5 Lot No.2
Site Plan Name: TOOMBS Block No. C W 71
Project Name: TOOMBS
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Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7500.00 Utilities::_ Sewer —Septic Building Height:
Name NORMAN TOOMBS
Name: FRANK RUSSO
Address. -902 ELYSE CIR
Company: FAMILY POOLS INC
City: PORT ST LUCIE State: _
Address: 873 SWS MACEDO BLVD
City: PORT ST LUCIE State: FL
Zip Code: 34952 Fax:
Phone No.772-332-4522
Zip Code: 34983 Fax:
E -Mail:
Phone N0772-878-8452
Fill in fee simple Title Holder on next page ( if different
E-MailNICHOLE@FAMILYPOOLSINC.COM
State or County License CPC1456929
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
NEW_
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:
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF ST WO
STATE OF FLORIDA -
I COUNTY OF S �w UG
Sworni (or affirmed) and subscribed before me N
✓Physical Presence or Online Notarizat "
this day of 2020 by .2 0 N
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Swoor (or affirmed) and subscribed before me of gco
Physical Presence or Online Notarizatio 's �N
this day of 12020 by o N
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Name of person making statement.c c
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Personally Known ✓ OR Produced Identific 42:�w
Type of Identification
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Name of person making statement. g'�._s
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Personally Known -s OR Produced Identificat n
Type of Identification
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(Signature of NotJry Public- State of Florida)
(Signature of Notaryli State of Florida )
Commission No. (Seal)
Commission No. (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEWS
FRONT
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/1