HomeMy WebLinkAboutBuilding Permit ApplicationALL Ad" PLICASLE INFO MUST BE COMP ,D FOR APPLICATION TO BE ACCEPTED
Date: � ro 1,� Permit Numb L
RECEIVED
NOV 2 6
Building Permit Applicatio ST ���;� �p
Planning and Development Services -- - - __. �NX'a''crmitting
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 f a�_�'4.9y®iurAuP=stOu[,cy=�a4t` nryr„Dd�"�IaMMlfuc�7�Ph R�a .. / _,•+em(1s�. ! ��:¢E51�` err3,�Ln3m*a&�m4gauA.S�7Fg �n�ggn�. r�' .y�<v,y��-v•:�}.,zJrfuFF�..S" W��-A�v..?4t 4'y". *,s
r�a.s. ��1 Address:
Legal Description: " _ "
Property Tax ID #: Lot No. 1v
Site Plan Name: 1 , Block No.
Project Name:
Setbacks Front Back: �� Right Side: Left Side: 30
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Installation of Gunite Pool; Deck and Equipment
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Additional work to be performedunder tis perm — check a11 a apply:
❑HVAC I—J Gas Tank Gas Piping _ Shutters a Windows/Doors
Electric it if Plumbing Sprinklers 11 Generator F]Roof
Total Sq. Ft of Constructiony-�� :b'_ 6N4 11 S . Ft. of First Floor:
Cost of Construction: $ 5 to )q UtilitiesSewer Eleptic Building Height:
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Name
Name: TerryWa
Address: G
Company: Pools by Greg, Inc.
City: r State: ,YJ,
Address: 8886 S Federal Hwy
Zip Code: _� C14q Fax:
City: Port St Lucie State: FL
Phone No.-�4_10L' ub15
Zip Code: 34952 Fax: 772-337-9287
Phone No. 772 337-9713 -
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail: office@poolsbygregine.com
from the Owner listed above)
State or County License: CPC1458338
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SU_ P.LENIENTAL:CONSTRUCTION LI,E,N LAW INFORMATION..
...
DESIGNER/ENGINEER:, _ Not Applicable
Name : M. RANDALL ROGERS
Address:1801 HAZELWOOD DRIVE
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: FORT PIERCE State: FL
Zip: 34982 Phone772-201-1634
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 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.
/,
STATE OF FLORIDA
a
COUNTY OF
The fq oing instr nt as ackn ledged before me
this ' ay of 20 by
TERRY WIX
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
ign-.,►c
�� � r „tom
Sature qf,Q ractor/,Len �o a Ild'er
STATE OF FLORID
COUNTY OF Ek 1AACa e
The f rgoing instrumentwas acknowledge before me
this day of 20 by
TERRY WIX
Name of person making statement.
Personally Known )C OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
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DATE
RECEIVED
10
DATE
�
•ty Notary Public S
ate of Florida
COMPLETED
'
A Thomasins
Bowins
ev.
FQ?
Nfury Pu is State of Florida
A Thom sina Bowins
e My Commission GG 201733
Expires 03129/2022
Q y Comr�ssion
of Expires 03/29/2022
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