HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE PLETED FOR APPLICATION TO BE ACCEPT
Date:, Permit Number:
RECEWED
Building Permit Application SEP 28
Planning and Development Services 2017
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 ie County FL
(Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residen a
PERMIT APPLICATION FOR: Pool inground
..T+�twrq rr -.�xa _•en �gva'^�a,-,caaY;,.�,�....y- 3x".�'ry �,s�*,�.=;,`ter s�jfiz sw`S?��},'"xw` "`?� S'"a .m"'�".�".��.�r uc+.�c,,�er �n _M:;� _'.ti "�k° ;��,*�?�'�.�{�' �"i .�,..Y �T3 r�°,s �#ri
Address: Wa
Legal Description:
/— aS_D`�2
Pi rope rty Tax ID#: �1 U 0 60-1 - 60 ' Lot No.
0
Site Plan Name: Block No.
PIroject Name: Y1) l
Setbacks Front Back: Right Side: _Left Side:
y�:- �.;_w�l.�`�-
� f -
fT�►IL�D�f�E �R=tt�,�tON��F ilVRl� �£ ��r_ -.��.�, =�ifiM �.� PF,%t�'� hb^.F,ttl�� >vb�>"4�#'Y ��.� vJ'' y.zr9P"
Installation of Gunite Pool, Deck and Equipment
itiona wor o e e orme un ert is perm —c ec a � app y:
�HVAC �Gas Tank ❑Gas Piping _Shutters �Windows/Doors ^
Electric Plumbing�GD J (05` Z �S prinklers Generator Roof
Total Sq.Ft of Construction: pa-VIZ)-SKIS S . Ft.of First Floor:
Cost of Construction:$ Y lf.'500.0 0 Utilities:'nSewer OSeptic Building Height:
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Name Lie ryrrl n(�►iar� Name: TenyWix
Address:_�32�� ml,tlr-FI�{G� (ail Company: Pools by Greg, Inc. '
Address: 8886 S Federal Hwy
Zip Code:_ Q�) CD Fax: ff City: Port St Lucie State:FL
hone No. SC��' yL1 (}�31� Zip Code: 34952 Fax: 772-337-9287
I E-Mail: Phone No. 772-337-9713
fill in fee simple Title Holder on next page(if different E-Mail: office@poolsbygreginc.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.
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SIUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: H r- Name:
Address: Address:
City: )yil-:11I.lIYI i3 ea 2-P, State:� City: State:
Zip: �33 N// Phone: _ 'a of 79-G.S-Gl/ Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Ap: Phone: Zip: Phone:
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
i I 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.
tL� ; s
Signature of O /Less a/Agent Signature of Con or/License H&der
STATE OF FLORIDA 51�:
STATE OF FLORIDA / _COUNTY OF .6 COUNTY OF _z
he for ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 JJby this J day of 20 A by
1
Name of pers acknowledging) (Name t perso cknowledging)
�(S' n tur f Notary-Public-State of Flor a) (Si a ure ry P otaublic-State of Florida)
0rersonally Known y OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Mill Commission No. (Seal)
JAYME RAVEZ
JAYME CHAVEZ
=°: •': MY COMMISSION#FF991925
= OMMISSION#FF991925
//;���y,"d,�; EXPIRES May 12,2020 y• �,�;
Revised 07/1 �y�ay153 FloridallotaryService.com g °a' EXPIRES May 12,2020
f407)398-0153 Florida NotaryService:com
REVIEW_S FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW.., .... REVIEW REVIEW
DATE
;COMPLETE
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II N ITIALS
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PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
I n
O O I1 (z 2 /11C: /c�(�(�► 1 x have agreed to be
(Company ame/Indivi al Name)
the 1 u I7.b i v q Sub-contractor for PD 0 )S
(Type of Trade) (Primary Contra tor)
or the project located atR_ ,(�90 ffilmAdd
(Project Street A dress or Property Tax ID#)
It is understood that,if there is any change of status regarding our participation with the above mentioned
(reject, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNAT Ir
Qualifier) SUB-CONTRACT NATURE( ualifier)
I/ZRRV M X / r-to is �U l
PRINT NA PRINT NA
COUNTY CERTIFICATION NUMBER COUNTY CERT ICATION�� C.c
NUMBER�T
fate of Florida,County off Q/ State of Florida,County of G
The foregoing instrument was signed before me this AJ day of The foregoing.instrument was signed before m•e this U day of
20—,by 7',�'► / ,20L1,by 12/ r/I �x
who is personally known_or has produced a who is personally known L--or has produced a
Is id e tification. as ibenlification._
STAMP l.C� STAMP
Sig a of t2fry Public Si ture otary Public
Jfivalmle. �
Print ame o otary Public Print Name of Notary Public �P
J
JAYAiIIE CHAVEZ ,Oois:YN�a JAYME CHAVEZ
�`a44n•-••R,
MY COMMISSION#FF991925 +: MY COMMISSION#FF991925
EXPIRES May 12,2020 ? A
ate:
Revised 11 16 EXPIRES May 12,2020
"" FlorldallotaryService.cam
(407)398-0153 (407)308.0153 FloridallotaryService.com _
PERMIT# ISSUE DATE
I
.. ,.�. PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
Pa y t E L e e T2►clkoo er'7' / a yu fig have agreed to be
(Company Name/Individual Name)
the C L ig e %2 tc R L Sub-contractor for 100d1-c-, 6 y R eq -
Tye-(Type of Trade) (Primary Contfactor)
For the project located at U f
(Project Street Address or Property Tax ID#)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
CONTRALTO ( TUR ualifier) SUB- rr CT SIG (Qualifier)
l (AV I Ob er Pa u k
PRINT T NA NAME PRINT NAME
/ 98y
COUNTY CERTIFICATION NUMBER, - COUNTY CERTIFICATION NUMBER
.State of Florida,County of l �i{.Q/ State of Florida,County of t
The foregoing instrument was signed before me this 01 day of The foregoing instrument was signed before me this AZday of
20�1,by_�� ,ly 4 Wl_ ,20JI,by 4 beili ioaqu L,
who is personally known//_/or has produced a who is personally known_fir has produced a
a§ entification. as entification.
o atis,•.�vc' 'o dam•,'ao;
ai• ,.W.
:ate.• .•,�+,
m = STAMI
e at re otary Public o qy, o; S atur ota Public §
Ig .� • ry � i.a '
Print Name otN to Public C)
ry o x Print Name
Notary Public o x 0 n
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Revised 11/16/2016 3 co (0 M a o (0 M
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PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGIWA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
Q
(Parcel I Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final-Development Permit, BP Number . I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code,I shall be responsible f4 assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I.further acknowledge that in granting this permit for the development of this property,
St Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will .not adversely affect the immediate
community.
Pro Prok,ty er N lease Pint)
f er Signature Date
JO ANNE WILLS
A Commission#FF 188304
STATE OF FLORIDA,COUNTY OF GC Lr o` Expires February 20,2019
' p�.f'�10 Bonded Thru Troy Fam Insurance NO365-7019
ACKNOWLEDGED BEFORE ME THIS DAY OF c , 20_17 ,
BYT�2�� AA.1/4Z 1-141/ WHO IS PERSONALLY KNOWNTO ME�)OR WHO HAS
PRODUCED AS IDENTIFICATION.
I A URE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
PLANNING&DEVELOPMENT SERVICES
BUILDING& CODE REGULATIONS DIVISION
.2300 VIRGINIA AVE
— —'— FORT PIERCE,FL 34982
(772)462-1553
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Swimming Pools,Spa,and Hot Tub Safety Act
FERAHT#
I(We)acknowledge that a new swimming pool,spa,or hot tub will be constructed or installed at
1h u.,k ri C(n 4)A-r� and hereby affirm that one.of the following methods
(Please print street address)
will be used to meet the requirements of Chapter 515,Florida Statutes: (Please initial the method used for pool.)
v The pool will be isolated from access to the home by an enclosure that-meets the pool-barrier requirements of Florida Statute 515.29.
The pool will be equipped with an approved safety pool cover that complies with ASTM F1246-91(Standaid Performance Specifications for
Safety Covers for Swimming Pools,Spas,and Hot Tubs).
All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that has a minimum sound
pressure rating of 85decibels at 10 feet
All doors providing direct access from the home to the pool will be equipped with self closing,self latching devices with release mechanisms
placed no lower than 54 inches above the floor or deck
I understand that not having one of the above installed at the time of final inspection,or when the pool is completed for contract
purposes,will constitute a violation of Chapter 515,F.S.,and will be considered as committing a misdemeanor of the second degree,
punishable by fines up to$500.00 and/or up to 60 days in jail as established in chapter 775,F.S.
I understand that the St.Lucie County Building Inspections Department assumes no liability for the final-inspection of one of the
above protective devices,or the lack of maintenance,or the removal of such after the swimming pool has been finalized.
I,the contractor,agree to instruct the owner of the proper use and maintenance of such safety device.
1
ONTRACTOR SIG _ O R SI A
ST TE OF FLORIDA, OUNTY OF STATE OF FLO A,COUNTY OF it/. C6
UBLIC NOTARY PUBLIC
The foregoing instrument wwas acknowledged before me The foregoing instrument was acknowledged before we
this day of ✓�(,/�/ ,20_ this day of ,20 �7
by A• by1C�2N J LSl r-g,
Personally Known /O or Produced Identification Personally Known V or Produced Identification
Type of identification Produced: Type of Identification produced:
`Q�p¢Y Ptie' JA1ME C'IANE� PY.P�' JO ANNE WILLS
SF, �6�4,
°= MY COMMISSION#FF991925 Commission#FF 188304
+ EXPIRES May 12,2020 a.- � Expires February 20,2019
SLCPDS R n s WM70 /Z010 ';;•; - Bonded Thm Troy Fein Insurance 800 385 7019
(ao7)398-0 53 FloridallotaryServico.com Af•
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Kenneth by Kenneth 6250 N.MILITARY TRAIL,SUITE 102-
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QSborne=leosso PHONE(561)640 48'00
(SIGNED) STATEWIDE PHONE(800)226.4807
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