HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPUCABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
- -- Building Permit Application
Planning and Deveio mentServices
Building and Code R ulation Division
23oo Virginia Avenu Fort Pierce FL 34982
Phone: (772) 462- 53 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLIC*TION FOR: Pool inground
Address: 0-1
Legal Description:
Property Tax ID #:r—
Site Plan Name:
Project Name:
Setbacks Front Back: ;�tA Right Side:
Installation of Guhite Pool, Deck and Equipment
Left Side: yl
Lot No.2` ``' i
Block No. - --
-Ad ltbonal worKto a errormea under [u[n pe[[[[u— ��oa n au ap.N.r.
0.HVAC Gas Tank ❑Gas Piping Mutters n Windows/Doors
Lr ('Electric i�� F1 5 Plumbing Sprinklers t �1 Generator O Roof
i r ..0 . q� ✓ Ir
} �ii` S . Ft. of First Floor.
Total Sq. Ft of Con ucfion: 1JQC,Y - 1 e m
` Septic Building Height:
Utilities Sewer _
Cost of Construction $ ` ► _
tdre
mMe
1
Name: Ten-ywot
Company_ fools by Greg, Inc.
City: Stater Address: 8886 S Federal Hwy
Zip CFelt:City: Fart St LucieState: FL
Phon'�� I Zip Code: 34952 Fax: 772-337-9287
E-Mail- I 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: CPCI458338
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW: INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
N am e: M. RANDALL ROGERS
MORTGAGE COMPANY: — Not Applicable
Name:
Address:1801 HAZELWOOD DRIVE
Address:
City: FORT PIERCE State: FL
Zip:34982 Phone772-2o1-1s3a
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
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 vour Notice of Commencement-
---------- ----
Signature of gwr�r/ Lessee%Contractor as Agent for Owner
Signature of Coh factor/Licefi'e Holder
STATE OF FLORIDA.
STATE OF FLORIDA r;
COUNTY OF s�� ,,�_i l
COUNTY OF_. _�, �� (C
The forgoing instru ent#as acknowledged before me
The forgoing instru rn, ent Was acknowledged before me
this day of ZO Ii by
this -- day of — .r 2 by
TERRY WIX
TERRY WIX
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known X' OR Produced Identification
Type of Identificati n
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida) f
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
.QYp�,,
Public State
fFlorida ¢1
Y
�1. - [T� � a My GoMM15. uu vv �.... �-
Q`�dP Expires 03/29/2022 5.
A Thomasina Bowinsv V
My Commission GG 201733
"Fof A Expires'3129/2022