HomeMy WebLinkAboutPERMIT APPALL APPLICABLE INFO
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: j
Building Permit Application
Planning and Develo
ment•Services
Building and Code Re
guladon Division
2-300 Virginia Avenue,Fort
Pierce FL 34982
Phone: (772) 462-1553
Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION
FOR: Pool inground
YY►
Address: J�
Legal Description:
Property Tax ID #:
Lot No.
Site Plan Name:
i 1 Block No.,93 ",?-
Project Name:
i
Back:. Right Side: � Left Side.5�,
Setbacks Front
Installation of Gu
ifte Pool, Deck and'Equipment
'Aclaitional
e e orme uri er is perm —c CKall apply.
worK to
Gas Tank ❑Gas Piping _Shutters o Windows/Doors
��OHVAC
LElect' "c
Q//P�lyum��bin OSprinkiers Generator F
Roof
Total Sq. Ft of Constr
uciion: _17PC L' 1, 1 S . Ft. of First Floor.
Cost of Construction
$ ���i 6 )�5 Utilities: Sewer Septic Building Height:
Name
IM
Name: TerryWk
Address:
Company: Pools by Greg, Inc.
City:
State: Address: 8886 S Federal Hwy
Zip Code:'
Fax: City. Port St Lucie State: FL
Phone No_
Zip Code: 34952 Fax: 772-337-9287
E-Mail:
Phone No. 772-337-9713
Fill in fee simple Title
Holder on next page (if different E-Mail: office@poolsbygreginc.com
from the Owner Usti
id above) State or County license: CPCI458338
if value of constructio
is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name: M. RANDALL ROGERS
Address:1801 HAZELWOOD DRIVE
City: FORT PIERCE State: FL
Zip: 34982 Phone772-201-1634
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: — Not Applicable
Address: Name:
City: Address:
Zip: Phone: 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.
is inconflictwith no
Owners Association) rules,will abylaws or and covenants that maly restrisubject
t or proh bit 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 1 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 QwrT r/ Lessee/Contractor as Agent for Owner
STATE OF FLORIQ
COUNTY OF I I 1 f`, ; P
The f oing instrupLent was acknowledged before me
this day of V ( 20 D ` 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)
Signature of Contractor/Licef�se Holder
STATE OF FLORIDA ,
COUNTY OF -I �11 ti )
The forgoing instrument was acknowledged before me
this _.�L 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) C
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE as
COMPLETED ^cam. otary Public State 4fFlorida
a My Commission GG 201733
Expires 03/29/2022
A Thomasina BowinsMy V
or ft�¢ Expires 3/29/2022 201733