HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INF
0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
- — .:..... _. .---
Building Permit Application
Planning and Development
Services
Building and Code Regulation
Division
7-300 Virginia AvenuE,
Fort Pierce FL 34982
Phone: (772) 462-1553
Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION
FOR: Pool inground
a
Address:
Legal Description:
Property Tax ID #:
t/ vt tl Lot No.
Site Plan Name:
Black No,
Project Name:
Setbacks Front .
i
Back: Right Side: Left Side:
H
lite Pool, Deck and Equipment '
lnstellation of Gu
Additionat wortotk
aHVAC
e nerformea under tnis perm —c ec a app y:
Gas Tank ❑Gas Piping a
_ Shutters Windows/Doors
Wlvectric
PlumOSprinklers
�bin�g Generator Roof
Total Sq. Ft of Con
JW
cii! n: ` i-g5V& S . Ft. of First Floor.
Cost of Construction
�
$ S ; S U V Utilities: Sewer aseptic Building Height--
Name!
�01111
Name: •terry vv
Company: Pools by Greg, Inc.
Address:
State: FL
Address: 8886 S Federal Hwy
Zip Code: :5LA S
Fax:
City. Port St Lucie State: FL
Phone No.
Zip Code: M52 Fax: 772-337-9287
E-Mail:
Phone No. 772-337 9713
Holder on next page (if different
Fill in fee simple Tits
E Mail• officeQpoolsbygreglnc•com
from the Owner listed
above)
State or County License: CPC1458338
if value of constructio
•is $2500 or more, a RECQRDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Not Applicabley
N a m e: M. RANDALL ROGERS
Address: 1801 HAZELWOOD DRIVE
City: FORTPIERCE State: FL
Zip. 34982 Phone772-201-1634
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: _
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 your Notice of Commencement
I
Signature of qr/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF_ l('�
The f r oing instrunient was acknowledged before me
this day of _J 20"� by
TERRY wx
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
i
Signature of Co ctor/Lice 'se Holder
STATE OF FLORIDA
COUNTY OF Luc—,1.
The for oing instrument was acknowledged before me
this day of 20
by
TERRY WIx
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION COUSEA TURTLE MANGROVE
NTER REVIEW REVIEW REVIEW REVIEW
DATE REVIEW REVIEW
RECEIVED
DATE
COMPLETED o:X P% otary Public State f Florida
Q My Commission GG 201733
Expires03r29/2022
A Tnomasina c U r�ond
My CommissionGG 201733
o, eta` Expires 03/29/2022