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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Plannin and Devel
Building Permit Application
t5
g opmen eres
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: SFR
PROPOSED IMPROVEMENT LOCATION:
Residential X
Address: 9400 Potomac Dr
Property Tax ID #: 2327-502-0118-000-1 Lot No. 110
Site Plan Name: _Creekside Plat #4 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Construction of a new single family residence
# of Bedrooms: 5 # of Bathrooms: 3 # of Garages: 2 Garage Swing: Left
New Electrical Meter Second Electrical Meter
CONSTRUCTION -INFORMATION:
Additional work to be performed under this permit —check all that apply:
X Mechanical Gas Tank Gas Piping Shutters X Windows/Doors _ Pond
X Electric X Plumbing Sprinklers
Total Sq. Ft of Construction: 3233
Generator X Roof Pitch
Sq. Ft. of First Floor: 2605
Cost of Construction: $ 177,815 Utilities: X Sewer _ Septic Building Height:
OWNER./LESSEE-
Name DR Horton Inc
Address: 1430 Culver Dr NE
City: _Palm Bay State: FL
Zip Code: _32907 Fax:
Phone No. 321-733-2111
E-Mail: MelbourneDermittina cDDRHorton.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: Brian W Davidson
Company: DR Horton Inc
Address:1430 Culver Dr NE
City: _Palm Bay State: FL
Zip Code: 32907 Fax:
Phone No 321-733-2111
E-Mail Melbourneoermittina(a)DRHorton.com
State or County License CRC1327068
.1 rm— V 1 bW113U UUM011 13 4JUU ur mvre, a KtLunutu Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name AB Design Group Inc. /Michael Anderson
Address: 2194 HWY A1A #301
City: Indian Harbor Beach State: FL
Zip: 32937 Phone 321-237-0436
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: —Phone:
—
x Not Applicable
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
x Not Applicable
State:
x Not Applicable
UVVINtK/ GUN I KACFUR 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing wnrk nr rpcnrdina vni it nlnri, of ('nmmonrorrion+
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Brevard
COUNTY OF Brevard
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
x Physical Presence or Online Notarization
this 4 day of March 2021 by
this 4 day of March_ 2021 by
Brian W Davidson
Brian W Davidson
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- " ......�., plplgppRRINO
MY COMMISSION 9GG 935643
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Commission No.
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No. a 27, 2024
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