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Date: J SCANNED Permit Number:
BY
_ St. Lucie County
Building Permit Application
MAY 0 2 2019
ST. Lucie County, Permitting
Planning and Development Services
Building and Code -Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Boat lift
PROPOSED IMPROVEMENT LOCATION:
n i iro«• 10701 S OCEAN DR LOT 857 JENSEN BEACH FL 34957
Legal Description: VENTURE OUT AT INDIAN RIVER INC LOT 857
PropertyTax ID #: 4511-510-0058-000-8
Site Plan Name: COSCULLUELA
Project Name: COSCULLUELA
Lot No.
Block No.
Setbacks Front Back: _� Right Side: Left Side:
DETAILED DESCRIPTION. OF WORK:
I . ur►1ish Ins-�a l � �c i anyu�a�shCYM m6 nal
ON INFORMATION:
1]HVAC U Gas Tank
11 Electric Plumbing
Total Sq. Ft of Construction::
Cost of Construction: $ L f l.lJlJ
OU
Piping _ Shutters ❑ Windows/Doors
nklers 0 Generator 1:1 Roof = Roof pitch
Sq� FFtt.I of First Floor:
Utilities:Sewer OSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name JUAN & NORMA COSCULLUELA
Name: ROBERT WILLIAMS
Address:16331 SW 50TH TER
Company: WILCO CONSTRUCTION INC
City: MIAMI State: FL
Zip Code: 33185 Fax: N/A
Phone No. N/A
Address: 10751 ORANGE AVE
City: FORT PIERCE State: FL
Zip Code: 34945 Fax: 772-460-6929
Phone No. 772-460-6928
E-Mail: JCOSCULL@CISCO.COM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: WILCOINC@BELLSOUTH.NET
State or County License: SCC131151026 29115
If value of construction is 52500 or more, a KEcoKuhu Notice or commencement is requueu.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: DANIEL PAUL RETHERFORD
MORTGAGE COMPANY: x_ Not Applicable
Name:
Address: 1402 HARTMAN RD
Address:
City: FORT PIERCE State: FL
Zip: 34947 Phone: 772-224-9826
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 coniylict 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
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
v s
Signaturd of Contractor/License Holder
STATE OF FLORIDAS.I—�
COUNTY OF JJ
The f r ping instr ent was ac c owledged before me The forgoing instru ntpLe _ was acknowledgedbefore me
this 17 day of M r�e�'I R r20 by this I day of � VJ� 20 � t by
Bifa �llti1l�urYl� ���1>e�F �l ! 1griv
(Name of —person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced -
Commission No.
Revised 07/15/2014
WCOMgjggj ii#GG162348
EXPIRES:December
_-
(Signature of�lic- Sta 6
of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No. DAWfi*GERALD
WC0MMISSI0N#GG.162348
Pii_•se GYDIRFS[D2Cefnber17,2021
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
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COMPLETE
INITIALS