HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE C(,..i LETED FOR APPLICATION TO BE ACCEPTED" 2 (�(/^�
Date: ��� ro70 02 Permit Number: V
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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: Pool inground
PROPOSED IMPROVEMENT LOCATION:
Address: 7107 S. INDIAN RIVER DRIVE
Legal Description: 12 36 40/07 36 41 beg on riv bank at ne cor of ankona cemetery run w 950 ft m/I to fecrr, th nwly alg rr 196.62 ft,
th ely to riv, th sly to pob with rip rts (21) (or 3618-647)
Property Tax ID #: 3412-414-0001-000-2
Site Plan Name:
Project Name: MATHIS POOL
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
CONSTRUCTION OF IN GROUND POOL WITH HEATER AND PATIO
CONSTRUCTION INFORMATION:
Additional work to be nertormed under
11HVAC L.J Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction: _
Cost of Construction: $ 63,500
Lot No.
Block No.
this permit — check all apply:
❑Gas Piping In Shutters Windows/Doors
Sprinklers E] Generator Roof
S Ft. of First Floor:
Utilities:Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MICHAEUSTACEY MATHIS
Name: JOHN M. MAY
Address: 7107 S. INDIAN RIVER DRIVE
Company: JM CUSTOM POOLS INC
City: FT. PIERCE State: FL
Address: 2503 DYER ROAD
Zip Code: 34982 Fax:
City: PORT ST. LUCIE State: FL
Phone No.
Zip Code: 34952 Fax:
E-Mail:
Phone No. 772-240-3268
E-Mail: jmcustompoolsinc@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: CPC1458456
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
SUPPLEMENTAL CONSTRUCWON LIEN LAW INFORMATION:
EER: _ Not Applicable
Name: M. RANDALL RODGERS
Address: 1801 HAZELWOOD DRIVE
City: FT. PIERCE State: FL
Zip: Phone: 772-201-1634
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 firsonspe on. If you intend to obtain financing, consult with lender or an attorney before
commencing,00rk or/ecording your Notice of Commencement.
STATE OF FLORIDA
COUNTY OF ST. LUCIE
Thef r ging instru-Went was acknowledged before me
thi ay of 20 -W by
(Name of p
re of
of Florida)
Personally Knowny OR Produced Identification
Type of Identification Produced
Commission Now
66 C? 0&91e.)
Revised 07/15/201
_ Notary g&@4tate of Florida
Kaylin J. May
s My Commission GG 906961
Signat re of Contract icense H Ider
STATE OF FLORIDA
COUNTY OF ST. LUCIE
The forgoing instrument was acknowledged before me
this 4& day of 5E-Pro l B j l= , 20-.0 by
�0H0 l44 -VH
(Name of person acknowledging
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.L13�J6_;r (Seal)
WILLIAM H DONOVAN R
MY COMMISSION # GG093576
EXPIRES April 12.2021
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