HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.-
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q (� `I
Date: /�/—/ Permit Number: "' `' Oq
Building Permit Application SCANNED
Planning and Development Services St.ltlrB �.f1llntlr
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Pool inground
I PROPOSED IMPROVEMENT LOCATION: III
Address: 4807 PALMETTO DRIVE
Legal Description: INDIAN RIVER ESTATES -UNIT 05-BLK 3 LOTS 27 AND 28 (MAP 34/02N) (OR 596-2727;
1067-909; 3347-1887, 1888;4030-2104)
Property Tax ID #: 3402-606-0003-000-4
Site Plan Name:
Project Name: KELLY POOL
Setbacks Front Back: Right Side: Left Side:
Lot No.27&28
Block No. 3
DETAILED DESCRIPTION OF WORK: II
CONSTRUCTION OF IN GROUND POOL WITH HEATERICHILLER AND CONCRETE PATIO
TRUCTION INFORMATION:/ ill
itiona wor to a oe orme under this oermit— check all that aoo V:
1_1HVAC 1-1 Gas Tank Gas Piping U Shutters
11Electric 0 Plumbing ❑Sprinklers ElGenerator
Total Sq. Ft of Construction: S Ft. of First Floor: _
Cost of Construction: $, ilav Utilities: Sewer OSeptic
❑ Windows/Doors
Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name DUANE KELLY
Name: JOHN M. MAY
Address: 4807 PALMETTO DRIVE
Company: JM CUSTOM POOLS INC
City: FT; ,PIERCE State: FL
Zip Code: 34982 Fax:
Phone No.
Address: 2503 DYER ROAD
City: PORT ST. LUCIE State: FL
Zip Code: 34952 Fax:
Phone No. 772-240-3268
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: JMPOOLS@BELLSOUTH.NET
State or County License: CPC1458456
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
P. ,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: M. RANDALL RODGERS
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: 1801 HAZELWOOD DRIVE
Address:
City: FT. PIERCE State: FL
Zip: 3448-A, Phone:772-201-1S34
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address: —
-City:
City:
Zip: Phone:
Zip: Phone:
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
Z`
STATE OF FLORIDA
COUNTY OF ST. LUCIE
The forgoing instrument was acknowledged before me
this_,3 dayofS4P-rF nh&0_ 20Aby
a'o ylL�- M • Y7'1 N
(Name of person acknowledging)
TSignature of Ngtary ublic- State of�lorida )
Lf/,.� rl / ✓ ✓�
Personally Known OR Produced Identification
Type of Identification Produced
Commission
Revised 07/15/2014
WILLIAM H DONOVAN
EXPIRES Apol 12, 2021
Sign at e o ractor se Holder
STATE OF FLORIDA
COUNTYOF ST.LUCIE
The forgoing instrument was acknowledged before me
this,ydayof SEPiE1nA 20_0 by
S2_Pd) of -mAY
(Name of person acknowledging)
(Signature o��ary pyblic- atete ) y✓
Personally Known .f OR Produced Identification
Type of Identification Produced
No. 66:-O
EXPIRES April 12.
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