HomeMy WebLinkAboutBUILDING PERMIT APPALL APPLICABLE IN `0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Develo mentServices
Building and Code R ulation Division
2300 Virginia Avenu Fort Pierce FL 34982
Phone: (772) 462- 53 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLIC
TION FOR: Pool inground
Address:
Legal Description:
Property Tax ID #•
�Lot No.
Site Plan Name:
Black No.
Project Name:
Setbacks Front
Back: Right Side: Left Side:
Installation of Gu
ite Pool, Deck and Equipment
e e armed un er is perm —c ec a a app y:
❑Gas 171 ]
Iona war o
ClHVAC
Gas Tank Piping shutters Windows/Doors
Ly iElectric
�j (
Plumbing OSprinklers ! =1 Generator t=i Roof
In: Ft. First Floor.
Total Sq. Ft of Const
I iS . of
0Sewer FISeptic
Cost of Construction
$ Utilities: Building Height:
MINE W
mas
Name JLL�
Name- To-Ywa
Company: Pools by Greg, Inc.
Address:IMO
State:Ll--
City;
Address: $$86 S Federal Hwy
Zip Code: 41CI
I Fax:
City: Port St Lucie State: FL
Phone No.
Zip Code: 34952 Fax: 772-337-9287
I
E-Mall-
Phone No. 772-337-9713 •
Holder on next page (if different
E-Mail: office@poolsbygreginc_com
Fill in fee simple Title
State or County License: CPCI458338
from the Owner list
d above)
I
if value of constructio
is $2so0 or more, a RECORDED Notice of Commencement is required.
SUPPLME ENTAL CONSTRUCTION LIEN LA, INFORMATION:
11
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: M. RANDALL ROGERS
Name:
Address:1so, HAZELWOOD DRIVE
Address:
City: FORT PIERCE State: FL
City: State:
Zip: 34982 P h o n e 772-201-1634
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 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 our Notice of Commencement.
LIZ—
Signature of Qwrr✓r/ Lessee/Contractor as Agent for Owner
Signature of Co.S ctor/Lice se Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 1���-�
COUNTY OF i 111C14'
The forgoing instrument was acknowledged efore me
this � day of 20�by
The forgoing instru nt was acknowledged before me
-A
this day of 20_!a) by
TERRY WIX
TERRY WIX
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
--r
(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
fFlorida
COMPLETED .�Y>k,� otary Public State
Y
eV. } c My Commission GG 201733 e or Florida
Expires 03129/2022 A Thomasind Bowins
'� 5
E y Commission GG 201733
d R_. •. or p Pires 03/29/2022