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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1113121 Permit Numbe �"��
Date:
O Uo LUCE ~�', RECEIVED
p =WIJ =r' Building Permit Application NOV . 4 2021
Planning and Development Services Permitting Department
Building and Code Regulation Division Commercial I R'sidential Xhst. Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982 j
Phone: (772)462-1553 Fax:(772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: Pa-t.t o
PROPOSEDIMPROVEMENTLOCATION: Batik o home _ , (.
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Address: 1 7 3 SF Cam-�no - St PSL 34952I I
Property Tax ID#: 3479 - 515-024E -000-6 i i Lot No. 12
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Site Plan Name: I i Block No. 2 9
Project Name: II
DETAILED DESCRIPTION OF WORK: :
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Pours ^oneaee a.7 back- 12c12j�{oatexs ( 1 ) #5 neba,�
Footet,s {pox 24x24 axe,a 'Aon {utune metal bt2 g
4" thtck 3000pst .w/(jtben i
New Electrical Meter Second Electrical Meter {Affidav t required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that ap ly:
_Mechanical _Gas Tank _Gas Piping _Shu ers ; LndoWs/Dcors —Pond
Electric _Plumbing _Sprinklers _Genterator I Roof I Pitch
Total Sq.Ft of Construction: 67 5 Sq.Ft.of First Floor: f
Cost of Construction:$ 5 8 0 0 1 Utilities: _SeTr _SeptiI.�l' Building Height:
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OWNER/LESSEE: _ CONTRACTOR: e .,
Name Donat d Mou Ute Beaux Name: 130se 1 V t ' e '
Address: 113. SF Camtino St Compan : Jo-s13 oncAez
City: PSL State: F I Address] i -ith Sibriae
Zip Code: 3 4 9 5 2 Fax: ry���,� City: PSL ) Il State:_,E I
Phone No. 772 8 1 2 5066 E- Zip Code: Fax:i Ai n n o
Mail: None Phone I o 2 i I
Fill in fee simple Title Holder on next page(if different E-Mail 5 2 3 0 1
from the Owner listed above) State or County,Licen e 2 5 2 3 40
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If value of construction is 2500 or more,a RECORDED Notice of Commencenr ent Is requireO.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIt�N:,, a I
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPA Y: { Not Applicable
Name: - Name: � I
Address: Address: I
City: State: City: State:
Zip: Phone Zip: I I Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY I Not Applicable
Name: Name:
Address: Address:
City:. City: I II I
Zip: Phone: Zip: I �Pho I I :
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OWNER/CONTRACTOR AFFIDVIT:;Application is hereby made to obtain'a permit to d l the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a li ermit. Le
St.Lucie County makes no representation that is granting a permitwill authorize the permit bolder to build subject structure
which conflicts with any applicable Homeowners ssocia ion rules,bylaws or a d covenants ghat may restrict or prohibit such
structure.Please consult with your Homeowners Association and review your deed for any r trictions whi h may apply.
In consideration of the granting of this requested permit,I do hereby agree th9t I will,In all r' peas,perform the work
In accordance with the approved plans,the Florida Building Codes and St.Luci�County Ame idments. {
The following building permit applications are exempt from undergoing a full cpncurrericy re'lew:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and a'ccessoryiuses o 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.
fi
Lucie County and posted on the jobsite before the rst inspection. If 'ou i, tend to obtain financing,consult
with lender or an attorne before commencing work or recordingour NdTice of Commencement.
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Signature o w r/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA j
COUNTY OF _� i i
Sworn to(or affirmed)and pubscribed before me of cal Presence or i Online Notarisation
this 1 —day of 1J 20' by I
Name of person making statement. i k
Personally Known OR Pro uced Identification
Type of Identification Produced_
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(Signature ot Notary Public-Stat of lorida)
Commission No. (Seal) H EATH E R iB U RO R D
�1Par rim,
2�� State'of Florida
-Nota
3+
;� aP m fission #GG � 32 b7ic
y, ommission Expires
February ' 6, 20;22
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