HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO *MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: � ®C11 Permit Number: 1 O I
cc��1ro RECEIVED
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Building Permit Application
Planning and Development Services
Building and Code Regulation, Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
APR 16 2011.
rQrmittfng Department
St. Lucie. Ccuntj
Residential X
PERMIT APPLICATION FOR: SWIMMING POOL
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Address: 9406 PINEBARK CT
Property Tax ID #. 1327-801-0057-000-0
Site Plan Name: GRBK GHOMEADOWOOD LLC
Project Name: BORTNICK
INGROUND SWIMMING POOL SPA AND PATIO
New Electrical Meter Second Electrical Meter
Lot No.168
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 972 Sq. Ft. of First Floor:
Cost of Construction: $ 70,000.00 Utilities: —Sewer —Septic Building Height:
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NameGRBK GHO MEADOWOOD LLC
Name: ROBERTS BRUHN
Address:590 NW MERCANTILE PL
Company: LOUDEN POOLS
City: PORT ST LUCIE State: _
Zip Code: 34986 Fax:
Phone No.
Address:4306 S US 1
City: FORT PIERCE State, FL
Zip Code: 34982 Fax: 772-465-1063
Phone No772-465-2700
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Pwxlisa@gmail.com
State or County LicenseCPC1458612
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.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: RP ENGINEERING
Name:
Address: 4727N HWAY AIA
Address:
City: VERO BEACH State: FL
City: State:
.Zip: 32963 Phone772-226.0224
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: 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 per it applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swi ing pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWN -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
wi+h Innrinr nr nttn rn ov hafnra rnmmanrinR Wnrl( Clr teen riling vour Notice of CaBnmencement.
Ignature of er actor as Agent for Owner
Sign ure o ontractor/License Holder
STATE OF I
STATE OF FL �
COUNTY OE J
Swo o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Sworn to (or affirmed) and subscribed before me of
�C Physical Pres n e or Online Notarization
—� 202it by
this day of 202/ by
this /STday of
/,c, iil i a m f il'o'/er
Name of person making statement.
ame of person making statement.
Personally Known ✓/ OR Produced Identification —
Personally Known OR Produced Identification
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Type of Identification
Type of Iden ica ion
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Commission No. �a�' ` I,y'G o��°e
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