HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 11 _dw
Permit Nunftftj � ��'
21ro aU 'M - - ... MAR I X 2021
�1 Permitting pz,
art
�Q fir. ti St. Lucie Count ent
Building Permit Application "
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Property Tax ID #: �.33�j%' ��Z QD/ J 'DOG ' !�, Lot No. Io Z
Site Plan Name: Block No.
Project Name: Z /7V / S
O %,7cS 6 4 /0'no
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Wind
Electric _10lumbing _Sprinklers _Generator _ P
Total Sq. Ft of Construction: l09�� Sq. Ft. of First Floor: gA
Cost of Construction: $ s�, ��0 , Utilities: _Sewer _ reptle,,�. r-I
_ Pond
Building Height:
Pitch
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Name
Name: ROBERTS BRUHN
Address: (a _6F17i
Company:LOUDEN POOLS
City:State: 15-
Zip Code: o�� I�`J Fax:
Address:4306 S US 1
City: FORT PIERCE State- FL
Phone No. TV o? / %
Zip Code: 34982 Fax: 772-465-1063
Phone N0772-465-2700
E-Mail Pwxlisa@yahoo.com
E-Mail: Gil a� aO-
Fill in fe simple Title Holder on next page ( if different
from the Owner listed above)
State or County License cpc1458612
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
TOTEiUCTI,QN�xN
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DESIGNER/ENGI EER: _I Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name
Name:
Addres :
Address:
City: / / G`.. I Stat
City:
State:
zip. Phone —'
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:IApplication 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 paying twice for
-improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or re -cording vour Notice of Com?, encement.
Signature o caner/ Lessee/Contractor
as Agent for Owner
Signature of ntractor/License Holder
STATE FL!r
COUNTY OF e_4_y_'
STATE OF
COUNTY OFO� 7�' Z4.4 fro
Sw rn to (or affirmed) and subscribed before
me of
SW rp to (or affirmed) and subscribed before me of
Physical Presence or Online
Notarization
Physical Presence or Online Notarization
this day of /L(h-f� 202,$
by
this day of 2020 by
ROBERT S BRUHN
Name of person making statement.
Name of person making statement.
Personally Known QR Produced
Identification
Personally Known x OR Produced Identification
Type of Identification &"
Type of Identification
Produced V
I
Produced,
�i
(Signature of Notarf Public- State nt.Fd
rida)
SHERRf FEHLMAN
gnature f Notary Publi State g tlg4'..da) SHERRbFEHLPJIAAN
Commission No. N -'
mmission # GG 18716
�5ea'
xpires March
� 2,: "
.fi h ij = mission # GG 18716
Commission No.,F ` ` Sea`
V4 vlftes March 14,
9,
FOF FLO�
,o 14, 2022
Bonded ThM Budget Notaryse '
ry, .r 2022
6 6� MUM iAN BWdyet Notary Servi
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