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ALL APPLICABLE INFO MUST BE IPLETED FOR APPLICATION TO BE ACCEP
Date: O �� O C." SCANNEDI
PermitNumber: D' 10
B
® St. LUCIP Count, RECEIVED
Building Permit Application OCT 3 0 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Pool inground III
Address:
Legal Description:
Property Tax ID #: d��� ' �V tY ' Wd�1 ' l �7t) ' r� Lot No.eon_
Site Plan Name: Block No.
Project Name: �Inf)Y�
Setbacks Front 1�ack: 9:5 a, Right Side: '&) Left Side:
Installation of Gunite Pool. Deck and Equipment
0HVAC LJGas Tank ❑Gas
ZElectric Tmbin34a�l�Spr
Total Sq. Ft of Construction: l �.
Cost of Construction: $ �O —1✓
Piping I-1Shutters ❑Windows/Doors
nklers 1:1 Generator 0 Roof
Sq��Ft.I of First Floor.
Utilities:nSewer El Septic Building Height:
i A-,���'+� k•, °-
' .�.e. .�xx �R�
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Name
Name: TerryWuc
Address: ��
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y
Company: Pools by Greg, Inc.
City: V-ty% State:
Zip Code: NA a Fax:
Phone No.,
Address: 8886 S Federal Hwy
City: Port St Lucie State: FL
Zip Code: 34952 Fax: 772337-9287
Phone No. 772-337-9713 ,
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: office@poolsbygreginc.com
State or County License: CPC1458338
If value of constructiori is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
Designer/Architect/Engineer.
❑ Not Applicable
Mortgage Company:
S Not Applicable
Name M . R &'AJc�
f G
Name
Mailing Address J Q, D 1 Her
2e I n r3 d 6R .
Mailing Address
city n rt P i t rC e—
State �
City
State
Zip 3y-1,2a Phone'}'}a—A01—
I to 3y
Zip Phone
Fee Simple Title Holder's Name: S Not Applicable
Bonding Company:
A Not Applicable
Name
Name
Mailing Address
Mailing Address
City
State
City
State
Zip Phone
Zip Phone
Notice to Owner. There are some properties that may have deed restrictions recorded upon them. These
restrictions may limit or prohibit the work applied for in your building permit It may be to your
advantage to check and see if your property is encumbered by any restrictions.
Owner/Contractor Affidavit: Application is hereby made to obtain a permit to do the work and installations as
indicated. I certify that no work or installation has commenced prior to the issuance of a permit.
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 Code 5th Edition (2014) and Martin County
Amendments. Plan revisions on all structures exempted by code from architect/engineer design may be done by
permit holder.
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 job site before
the first inspection. if you intend to obtain financing, consult with your lender or an attorney before
commencing work or recording your Notice of Commencement.
1 certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
Signalu�esof6�Lr4TAgerit/Lks ee
STATE OF FLORIDA
COUNTY OF MARTIN
The fore oing instrument was acknowledge before me
thisday of 201 y
rry X
(Name of Person Acln wledging)V
Y
(Signature of Notary Public —State of Florida) CIS
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known --OR Produced Identification
Type of ldentificano Produced
Notary Public State of Florida
GG 201733
Expires
t iatiire`vf�(�yrt ctb3/,1� Cense:ll`older�
STATE OF FLORIDA
COUNTY OF MARTIN
The fo oing instrument was acknowledged before me
thisdayof 201Iby
(Name of Person Aclmo
(Signature of Notary Public —State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known OR Produced identification_
Type of Identification Produced
Public State of Florida
My Commission GG 201733
Expires 03/292022
T:\BLD\Bldg_Forms\New Applications\Applications\Building Permit Application.Doex Rev. 8/10/15
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