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ALL APPLICABLE IN 0 MUST BE COMPLETED FOR APPLICATION TOPE ACCEPTED
Date: � �� Perntit Number.Building Permit Application
Planning and Develo en,Services
Building and Cade R lotion Division
2300 Virginiv Avenue,Fart Pierce FL 34M
Phone:(772)462- 53 Fax:(772)a62-15ys Commercial Residential X
PERMIT APPU TION FOR: pool ingrnund
Address: �l
Legal Description`
Property Tax ID#: c� ' D Lot No.�
Site Plan Name: Block No. �
Project Name-
Setbacks Front . Back J 'v Right Side: ���• Left Side: _
Installation of GU lite Pool, Deck and-Equipment .
0 N
Ana .wa o MUMS perm — ec aMa ON pp .
HVAC Gas Tank Das Piping Shutters �N/indows/Doars
O'Electric ✓ Iumbi Spsiniders Generator Roof
Total Sq.Fit of Co ctio'n: S .Ft,of Furst Floor.
Cost aF Construction $ "I Utilities:
Sewer O Septic Building Height:
u 3- to
Name Name: TenY�
Address: Company: Pools by Greg.Inc.
City: State: Address' 8886 S Federal Hwy
Zip Code: CI Fax: ; Port St Lucie State:FL
Phone No. I lag - 3 rip Code: 34852 Fax; 772-M7-9287 -
E-Mail: phone No. 7,72-337-9712
Fill In fee shnple TM t Holder on next page{If different E-mail: officeaPoolsby9ie9imcom
from the Owner IM d above) State or County Incense: CPCI45M
it value of coosbuctio is$zM or more,a IWWRDM Notice of Conmeneement is requhxd&
0151
SWOOP,
DESIGNER/ENGINEER: _Not Appkcable MORTGAGE COMPANY: Not Applicable
Name:KRANDALLROcl:as Name:
Address:W HAZELWOODDRiVE Address:
City: FORrwERce State: F City: State:
` Zip: 34m PhoneM-zoMMt Zip: Phone:
I
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.
it I certify that no work or installation has commenced prior to the issuance df 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:raom 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 or/Lic 'se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �T �_Q COUNTY OF 6� Ulf(u
The forgoing-instrume t was acknowledg d before me The fo oing instrument was,acknowledg d before me
this j-b day of IYU1120 by this day of 20 :by
TERRY WIX TERRY OX
Name of person making statement. Name of person making statement
Personally Known �?Q _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
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
,�++� OtwPutstiastow
COMPLETED Florida .
eV. . t • M,1 Commission GG 201733 a
A Thomasina BowIns
w ExQ�tes 03129I20Z2 � MpC- inn ss GC,.209733
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