HomeMy WebLinkAboutCCF_000261All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A /2- Z 12 Q 2 0
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: P e root -
Permit Number:
Building Permit Application
Commercial Residential X
Address: 2612 AVC Et -P10 -CC EL
Property Tax ID #: 2 -4 Oy -COOS - O OCO -l - O O O - 151 Lot No.
Site Plan Name:
Project Name:
P_ ew()yC 4 (ePIcicC thQ ex►s-br-� (� roof Sy,,ren1 wIt-() (;►rA
6)1, (_V)ItC CtUY(4� sv)i ngtC s.,sfiem.
CONSTRUCTION INFORMATION.
Additional work to be performed under this permit - check all that apply:
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator x Roof -3 1 1 2 Pitch
Total Sq. Ft of Construction:y1 (0 O
Sq. Ft. of First Floor:
quo
Cost of Construction: $ (0 .6-D O O -00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
Name INDIA wo CEJ
Address: I I O5 Fi er61 0 C K CI r
City: Ft . I Q r C e State: F-L
Zip Code: Fax:
Phone No. -1 -12 ) L- - I O- I 20
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: L10\I CSI COnSfiGirl*
Company: icinaYUS 20oFII1jConr Indic
Address: 21 -0 U P -H 6i r)ti (_ 1A V e
City: Pi-. P I e V c t? State: FL
Zip Code: - y Cl I -1 Fax:
Phone No (-112-) 41CJ -UG�I�
E -Mail 6'1r) lUS (OnS(1 U C101 I�c�i!�Vy iGil l
State or County License C L L I Z 7 Z S
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
Citv:
Zip: Phone:_
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
_ Not Applicable
tate:
Not Applicable
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 thepermit 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 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 NTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER DR AN ATTORNEY BEFORE RECORDING OUR TICE OF C)O"MEFICEMENT.77
Rev 2/7/19
1A 17
Signal e of Owner/ Lessee/Contractor as Agent for Owner
Sig at of Contracto is se Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTS
COUNTY OF
OF t.
The forgoing instrument was acknowledged before me
The foreoing instryment was acknowledged before me
this22rv_ day of s 20_LL) by
this22n!,1.ay of e2tC ill )Oe Y , 2020 by
LI J d (�� n �T r in
Name of person making statement.
U n\j a ( n n,t no i
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
Produced
(Signature of N t Public- State.a
�✓ -
(ASHLEY DEAN
mission No.` -i �� _� ,j! �`_a}Y Public -State of Fl
d8 = Commission M GG 978
8 d , sson Ex
�\ My Commission
_
(Signature of No Public 1r2 " ��I�ida
otary Public -State of Flor
•_ Commission p GG 9783
Commission No.! Q �?� (Sea[l�mmission Expire
„ p it
r , April 14, 2024
April 14, 2024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19