HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� �n
Date: tyl 4- 0 Permit Number:Q S(0 —y 51
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BY
• St. Lucie County aln
iiiiiiiiMMMOWMW Building Permit Application
Planning and Development Services ocr2;3. ft
Building and Code Regulation Division Permitting pa
2300 Virginia Avenue, Fort Pierce FL 34982 St. Le �-unryent
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential s(
PERMITTYPE: SINGLE FAMILY RESIDENTIAL
p PROPOSED IMPROVEMENT LOCATION:
Address: 1313 Lone Pine Drive, Fort Pierce, Florida
Property Tax ID #: 3409-505-0026-000-2 Lot No. 21
Site Plan Name: TILLBERG RESIDENCE --LOT 21, LONE PINE SUBDIVISION Block No.
Project Name: TILLBERG RESIDENCE
DETAILED DESCRIPTION OF WORK: zi I
CONSTRUCTION OF A SINGLE STORY CBS RESIDENCE WITH FOUR BEDROOMS/THREE BATHSrfWO C
GARAGE 2778 SQUARE FEET LIVING/3571 SQUARE FEET TOTAL UNDER ROOF
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric Plumbing /_Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 3571 V Sq. Ft. of First Floor: 3571
Cost of Construction: $ Utilities: _Sewer _Septic Building Height: 25'
OWNER/LESSEE:
CONTRACTOR:
Name WILLIAM & DANA TILLBERG
Name: SUSAN BARBER
Address: 807 NW GREENWICH COURT
Company: GEM BUILDERS, INC
City: PSL State: _
Zip Code: 34982 Fax: NONE
Phone No. 772-475-0667
Address: 1321 LONE PINE DRIVE
City: FORT PIERCE State: FLJ
Zip Code: 34982 Fax: NONE
Phone No 772-201-8434
E-Mail:—wtillberg@gmaii.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail susiegem3@bellsouth.net
State or County License CRC036620 STATE
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.
T
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:,
DESIGNER ENGINEER: _ Not Applicable
Name; RAUL R.VALELLA, ARCHITECT
MORTGAGE COMPANY: _ Not Applicable
Name: CENTERSTATE BANK, NA
Address: 138 SE NARANJA AVENUE
Address: 1951 8TH STREET NW
City: PSL State: FLA
Zip; 34982 Phone 772-871-2457
City: WINTER HAVEN, State; Fa
Zip: 33881 Phone: 863-804-0281
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: SAMEASOWNER
BONDING COMPANY: _Not Applicable
Name; NONE
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 ICE-0 OMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEM S TO YOUR PROPE A NOTICE COMMENCEMENT MUST BE RECORDED AND
POSTED ON T B ITE BEFORE THE FIRS INSPECTION. IF Y U END TO OBTAIN FINANCING, CONSULT
WITH YOUR NO O AN ATTORNEY BEFO E RECORDING YOU ICE OF COMMENCEMENT."
of Owner essee/Contractor as t for
ature of Contractor/License Holder
STATE OF FLORIDA � 1 nZ
STATE FLORIDA � (Q p 1
COUNTY OF �J
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COUNTOY OF wvw�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this�day of f g0� by
this��lay of 2�n_ 204 by
sLXS0't-� !BMVAQk
S�u_c; C%J-\ o a Aaec
Name of person making statement.
Name of person making statement.
' /
Personally Known OR Produced Identification
Personally Known OR Produced IdentificatiorV
Type of Identification
Type of Identification .�j )
Produced �, �
Produced ` dD
(Signature of Notary Public -State of Florida)
(Signature of Notary Public-S ate ;P1)
"" ELLEN VAUGHN �'aC
Com A, 3t�aafffaridaMotar Pti81c
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Com i�Sc�, &40 o �; — :"s soots OR re of
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= Commission # GG 270079
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October
2, 2022
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ROVExp
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
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REV 50
DATE
RECEIVED
DATE
COMPLETED
Rev. Z/7/19 V 1s — v