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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:
c-'
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: SFR
PROPOSED IMPROVEMENT LOCATION:
Building Permit Application
Commercial Residential x
Address: 9620 Potomac Dr
Property Tax ID M2327-502-0134-000-9 Lot. No. 126
Site Plan Name: Creekside Plat#4 Block No.
#1 Project Name:
DETAILED DESCRIPTION OF WORK:
Construction of a new single-family residence
# of Bedrooms: 4 # of Bathrooms: 2 # of Garages: 1
Garage Swing: L
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
X Mechanical _Gas Tank _Gas Piping _Shutters X Windows/Doors
X Electric X Plumbing
Total Sq. Ft of Construction: 2362
Cost of Construction: $100,540
_Sprinklers _Generator X Roof
Sq. Ft. of First Floor: 1828
Utilities: X Sewer —Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name DR Horton Inc
Name: Brian W. Davidson
Address: 1430 Culver Dr NE
Company: DR Horton Inc
City: Palm Bay State: FL
Address: 1430 Culver Dr NE
Zip Code: 32907 Fax:
City: Palm Bay State: FL
Phone No._321=733-2111
Zip Code: 32907. Fax:
E-Mail: MelboumeaermittingCabdrhorton.com
Phone No 321-733-2111
Fill in fee simple'Title Holder on next page ( if different
E-Mail Melboumepermitting@drhorton.com
from the Owner listed above)
State or County License CRC1327068
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name: AB Design Group Inc
Address: 551 S Apollo Blvd,
City: Melbourne State: FL
Zip: 32901 Phone: 321-237-0436
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name:
Address:
City: lia
Zip: Phone:
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: X Not Applicable
Name:
Address:
City:
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
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
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 5 day of APRIL 2021 by
this-5—clay of APRIL , 2021 by
Brian W. Davidson
Brian W. Davidson
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary Pu
(Signature of Notary Publi
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REVIEW
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DATE
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