HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0-- 0
Mr. LUCE-
0
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
PERMIT APPLICATION FOR:
'107-0, 'NEW1,00,01700,
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4 'aill
Address:
z'? Lot No//�
Property Tax I D
Site Plan Name: Block.No.
Project Name: '6041
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New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit- check all that apply:
—Mechanical — Gas Tank —Gas Piping —Shutters Windows/Doors Pond
Electric L-15rumbing —Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 64 Utilities: —Sewer _Septic Building Height:_
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Name: ROBERT S BRUHN
Company: LOUDEN POOLS
Address.-4306 S US 1
Zip Cod9 Fax:
e.
City: FORT PIERCE State: FL
Phone No.-&
Zip Code: 34982 Fax: 772-465-1063
E-Mail:
Phone N0772-465-2700
Fill in fee simple Title Holder on next page if different
E-Mail pwxlisa@yahoo.com
State or County License cpc1458612
from the Owner listed above)
If value of construction is 7500 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:. /60 2!�IJ4/1-JI-f f- G1
_
Name:
Address: Lf7 A-- -,9-
Address:
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City: State:
Zip: Phone ` � - v z��— -
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Marne:
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 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 lenrim der or 8n-atl Qrnev before corencini work bt recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
ignature bf Contractor/License Holder
STATE OF FLOR DA
STATE OF FLORIDA
COUNTY OF _ �t
COUNTY OF C.
Svforn to (or affirmed) and subscribed before me of
Sw to (or affirmed) and subscribed before me of
�` Physical Pres or Online Notarizati n _
�sical Pres a or Online Notarization
thi ) day of �i 202/ by
this day o ._ . 202A( by
S BRUHN
ame of fierson making statement.
Name of person making statement.
Personally Known -- OR Produced Identification
Personally Known x OR Produced Identification
Type-citJd ificatio
Type of Identification
P uced
od
Pr d
Signature of tary PSI c- St5"f'Florida1HERR FFEHLMAN
ignature o . ota ublic- State ofo Wri* SHER
°
Y
Commission No. (r 1891on # GG 187180
* a
commission # GG 187
Commission No.1 al) Expires March 14, 20
w rot Maralr 14, 2022
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DATE
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Rev. 5/6/20
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