HomeMy WebLinkAboutPERMIT APPSI
ALL APPLICABLE IN
O MU5T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development
Services
Building and Code Re
gulation Division
2300 Virginia Avenue,
Fort Pierce FL 34982
Phone: (772) 462-1553
Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLIC
TION FOR: Pool inground
Address: a ,
Legal Description:
Property Tax ID #:
r `
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front
I Back: �� Right Side:
� ! Left Side:
MINIM
Installation of Gu
ite Pool, Deck and Equipment
:Aclait.ional
work to
e efformed un ert ispermit—check
ll apply:_
0.HVAC
Gas Tank Gas Piping
FIShutters e ] Windows/Doors
Plumbing 13Sprinklers
Generator
_`Electric
t
kUAA
Roof
Total Sq. Ft of on
coon: 0ef"t—
SQ. Ft.of First Floor:
Cost of Construction
$ `` ( Utilities: 05ewer Septic Building Height:
._
Name: TeiCr woc
Name 1
Address:
Company: fools by Greg, Inc.
State:
Address: 8886 S Federal Hwy
City: :
Zip Code:CJ
Fax:
City: Port 51: Lucie
State. FL
Phone No.L4
1 • 3M
Zip Code: 34952 Fax: 772-337-9287
E-Mail:
Phone No. 772-337-9713 -
I Holder on next page (if different
d
E-mail: offlce@poolsbygreginc-com
R11 in fee simple Titl
from the Owner list
CPC1458338
above)
State or County License-
If value of constructio
is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW. INFORMATION:
DESIGNER/ENGINEER: — Not —Applicable pp
MORTGAGE COMPANY: Not Applicable
Name: M. RANDALL ROGERS
-
Name:
Address:1801 HAZELWOOD DRIVE
Address:
City: FORT PIERCE State: FL
City: State:
Zip: 34982 Phone772-201-1634
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 nowork or installation has commenced prior to the issuance of a permit,
s no
oy
which is inoconflict with any applicablelon Home at is Owners Association lt will rules,authorize the by bylaws or and covenants iser to that may restrithe ct oirpr structure
bits 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.
C�t
Signature of Qw!�r/ Lessee Contractor as Agent for Owner
Signature of Coftf ctor/Lice 'se Holder
STATE OF FLORIDA,
COUNTY OF
STATE OF FLORID
t
COUNTY OF 'bit
The forgoing instrum n as acknowledge,�, �dbefore me
this day of 20 by
The forgoing instru ment was acknowledged before me
Q'-9
thisE� day of ` 20al by
TERRY WIX
it
TERRY WIX
Name of person making statement.
Name of person making statement_
Personally Known OR Produced Identification
Personal) Known
Y OR Produced Identification
Type of Identificati n
Type of Identification
Produced
Produced
A
{Signature of Notary Public- State of Florida j
(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 07,
COMPLETED ,Q• •�� otary Public State f Florida".
ev.
:. y a My Commission GG 201733 e o ,onoa
Expires 03/29/2022 A Thomasina Bowins
My commission GG
Expires03/29/20201733
22