HomeMy WebLinkAboutBUILDING PERMIT APPLICATION i
I
ALL APPUCABLE IN IO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Develo meat Services
Building and Code R gulation Division
2300 Virginia Avenu Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLIO TION FOR: Pool inground
fl _ - -
_.
Address
Legal Description:
Property Tax ID#: `� ®� Lot No. _
Site Ptan Name: fy Block No.
Project Name: G
Setbacks Front Back cRight Side: • ' Left Side:9 L , ,
r
"^ :IN
Installation of Gu ifte Pool, Deck and Equipment
1 Iona wor o e e orme un er�µlsperm —c ec a � appy: s
IHVAC Gas Tank ❑Gas Piping (�Shutters F]Windows/noors
✓0Electric �✓ Plu b' g Sprinklers M n
Generator L�1 Roof
Total$q.Ft of Con ioe S .Ft_of First Floor:
T
Cost of Construction $ ') , 't U- i Utilities Sewer F]Septic Building Height:
OW .
Name Name: Tarry Wog
Addre �," Company: pools by Greg, Inc.
City: i L, State:L Address: a8$6 S Federal Hwy
Zip Code: Fax: City: Port St Lucie State:FL
Phone No. Zip Code: 34952 Fax. 772-337-328T
E-Mail: i Phone No. 772-337-9713
Fill in fee simple Titi a Holder on next page[if different i-Mail, office0poolsbygreginc_com
from the Owner list d above) State or County License: CPC1458338
if value of constructio is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW,tNFORMATION:
DESIGNER/ENGINEER: i Not Applicable MORTGAGE COMPANY: _Not Applicable
N a m e:M.RANDALL ROGERs Name:
Address:1801HAZELWOODDRIVE Address:
City: FORTPIERCE 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 no work or installation has commenced prior to the issuance of a permit.
St.Lucie Count 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 qv r/Lessee%Contractor as Agent for Owner Signature of Con-&ktor/Lice6se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF td 1-1 CA COUNTY OF 1A a b
The f2 oing instrument was acknowledged before me The fo ing instrument was acknowledged before me
this J day of �e_ 20a1 by this day of V C( 20�A by
TERRY WIX TERRY WIX
Name of person making statement. Name of person making statement.
Personally Known_:�&_OR Produced Identification Personally Known _K 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 *°tiv otary PublicState (Florida +Y
ev.9/26/18 RPA
k v My Commission GG 201733 o fonds
Expires 03129/2022 A Thomasina owins
�aMy Commission GG 201733
1 of Expires o3/29/2022