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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/2019 permit Number:19
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WMENOMMENOW Building Permit Application
Planning and Development Services JAN 08 2019
Building and Code Regulation Division ST. Lucie.County, Pera
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Building III
PROPOSEDIMPROVEMENT LOCATION: SCANNED
Address: Cody Ln ) M 5
Legal Description: Country Living Estates s/d bilk B lot 4 —
Property Tax ID #: 2305-500-0016-000-2
Site Plan Name:
Project Name:
Setbacks Front 226.6 Back: .Oti RightSide:G2. Q_ LeftSide: 52.�A
Lot No. 4
Block No.
DETAILED DESCRIPTION OF WORK: III
Ip, up Meal buMdng� povr/`n� co�Ic�e,Le� 3SxyJ_X1(oBv1ld1"`)
"nov;n� 3 -Sn,4ii ac"' freer) 6r.•nS,'�� , n e te4- f0 e1cV6*'&^
CONSTRUCTION INFORMATION: III
11HVAC 0 Gas Tank ❑Gas Piping U Shutters ❑ Windows/Doors
DElectric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: /f 7S S Ft. of First Floor:
Cost of Construction: $ ?0 )000 Utilities:SewerE]Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Chelsea and Justin Beebe
Name:
Address:3141 South Brocksmith Rd
Company:
City: Fort Pierce State: R
Zip Code: 34945 Fax:
Phone No.772-216-3364
Address:
City: State:_
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
_
Address:
Address:
City: State:
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: 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Sig ture of Owne6/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA II
STATE OF FLORIDA
COUNTY OF . LI
COUNTY OF
The f oing instru ent was acknowled���7i before me
thisydayof ��RIA 2U—I by
The forgoing instrument was acknowledged before me
this_ day of ,20_by
Name of person making statement /
Name of person making statement
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Identifi ion
Type of Identification
Produced
Produced
(Signal re of Notary Publi S(ata,q o
�zovA•=ec, EN S. NIELSEN
r.:Stat of Florida -Notary Publ
Commission No. _ C t� IFsion a GG 207484mmission
My Commission Expires
June 12, 2022
ignature of Notary Public- State of Florida )
c No. (Seal
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Rev.B/2/17