HomeMy WebLinkAboutBUILDING PERMIT APPALL APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
now Building Permit Application
Planning and Develo imentServices
Building and Code Ri gulation Division
2300 Virginia Avenu Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLI TION FOR: Pool inground
Address: D'V',
Legal Description:
Property Tax ID #
Site Phan Name:
Project Name:
Setbacks Front
Installation of
Total Sq. Ft of Const t
Cost of Construction $
Name: - �V�
Address:`6b�
City: l_-
Zip Code:
Phone No.Lb9-_-
Fill in fee simple
from the Owner
if value of constru4
!1\7o\1\01Iff=1IMILE
Back: Right Side:
Pool, Deck and Equipment
Left Side:
. v....cw w -Wl MIND MCI11111. — uigf,R 411 dppty:
Gas Tank ®Gas Piping _Shutters
Plumbing Sprinklers Fi Generator
tA
rn: Sq.
of First floor: _
Utilities: L _( Sewer n Septic
—State: t-L-
Fax:
Holder on next page (if different
I above)
Lot No. LA
Block No.
j� Windows/Doors
i�t Roof
Building Height:
Name: TeRYyync
Company: Pools by Greg, Inc.
Address: 8886 S Federal Hwy
City: Port St Luce State: FL
Zip Code- 34952 Fax- 772-337-9287
Phone No. 772-337--9713 '
E-Mail: office@poolsbygreginc.c om
State or County License: CPC1458338
t
is $25W or more, a RECORDED Notice of Commencement is required.
af
DESIGNER/ENGINEER: i Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name: M. RANDALL ROGERS
Name:
Address:
Address: 18o1 HAZELWOOD DRIVE
City: FORT PIERCE State: FL
City:
State:
Zip: 34982 Phone72-201-1634
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 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 Nome 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
commencing work or recording your Notice of Commencement.
Signature of -r/ Lessee/Contractor as Agent for Owner
Signature of Co ctor/Lic 'se Holder
�,
STATE OF FLORI` n
COUNTY OF ;7A \X I� C
STATE OF FLORigPt
COUNTY OF ` T
,
The f9Tgoing instru ent was acknowledged before me
day
The forgoing instrume t was acknowledged,before me
9�
this of _ 20_abby
this day of 20 by
TERRY WIX
TERRY WIX
Name of person making statement.
Name of person making statement.
Personally Known _2!�,_ OR Produced Identification
Personally Known _)�_ OR Produced identification
Type of identification
Type of Identification
Produced_
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida j t
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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f Florida
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