HomeMy WebLinkAboutBuilding Permit Application I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
9
Building Permit Application
Planning and Develol imentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462- 53 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLIC TION FOR: Pool inground
" - Sam � -
Address-
Legal Description:
Property Tax ID,#: .J Lot No.
Site Plan Name: Block No.
mo
Project Name:
r��j l��1 � ��►���Ir
Setbacks Front Back: 1 1� Right Side: Left Side:
Installation of Gu lite Pool, Deck and Equipment
Additional work to e performed under this permit—check a apply:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
b !;Electric WiPiumbing Sprinklers Generator Q Roof
1 305
Total Sq.Ft of Consti uctio CY ', 1 S . Ft.of First Floor:
Cost of Construction $ � ,� Utilities:Sewer FISeptic Building Height:
HIM OR, WMNMNI
-
Name PIMA Name: Terry woc
Address: q b r Company: Pools by Greg, Inc.
City: a 9 1 State: Address: 8886 S Federal Hwy
Zip Code: Fax: city: Port St Lucie State:FL
Phone No. 55U 71 Zip Code: 34952 Fax: 772-337-9287
E-Mail: phone No. 772-337-9713'
Fill in fee simple Titt 3 Holder on next page(if different E-Mail: office@pooisbygreginc_com
from the Owner listed above) State or County License: CPC1458338
If value of construetio 'is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPIVfENTAL CONS�RUCTIflN LIEN !AW _ QRl4TIQN: IT
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:M.RANDALL ROGERS Name:
Address:'8o1 HAZELWOODDRIVE Address:
City: FORT PIERCE State: FL City: State:
Zip: 34982 Phone772-201-1834 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 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 our Notice of Commencement.
Signature of r/Lessee/Contractor as Agent for Owner Signature of Co ffll!#Ctor/Licefise Holder
STATE OF FLORID p STATE OF FLORIDA
COUNTY OF COUNTY OF
The Nor going instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20� by this day of 20_ by
TERRY WIX TERRY WIX
Name of person making statement. Name of person making statement.
Personally Known�_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) '
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 Y�Pft&%,, O�taryPUbfir,�State Florida #:
r
ev. e o Honda
c_ e My Commission GG 201733 A Thomasina Bowins
Expires 03129/2022 C My Commission GG 201733
r as a Expires 03/29/2022