HomeMy WebLinkAboutAPPB COCAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 04120/21 Permit Number: 1906-0537
9r. LLrCE[ ,..-
9u�_A' 3 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Residential X
PROPOSED IMPROVEMENT LOCATION;
Andress: 12375 Skymaster St
Property Tax ID #t: 4224-501-0026-000--6 Lot No.26
Site Plan Name: Bussey Treasure Coast Air Park Bloch No.
Project Name: Bussey
DETAILED DESCRIPTION OF WORK:
New residence/ Hanger
2 bed/2 bath
New Electrical Meter X Second Electrical Meter
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
2', Mechanical — Gas Tank —Gas Piping
_ Shutters - Windows/Doors Pond
lectric ')( Plumbing Sprinklers
— Generator Roof 1112 Pitch
Total Sq. Ft of Construction: 6000
Sq. Ft. of First Floor:
Cost of Construction: $ 58,235.00 Utilities: _ Sewer _,� Septic Building Sleight: 21'
OWNER/LESSEE;
CONTRACTOR:
NameAlexander Bussey
Name: Michael Jackson
Address:6$62 Monmouth Rd
Company_Jackson Construction Group, Inc
city: West Palm Beach State:
Address:13043 53rd Ct N
Zip Code: 33413 Fax:
City: West Palm Beach State: FL
Phone No.561-762-7559
Zip Code: 33411 Fax:
Phone No561-308-0730
E-Mail. abusseywpb@gmail.com
Fill in fee simple Title Holder on next page ( if different
E-Mailbonnielcg@yahoo.com
from the Owner listed above)
State or County LicenseCGC1519160
.—vl W: Ir IIJLI I.IL JVII 17 LwAVW VI IIIV] C, a RC CORUL61 Notice or 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: X Not Applicable
Name:
MORTGAGE COMPANY: x Not Applicable
Name: i
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER; x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
Name -
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
vvviyERJ LuN7 RAF -TOR 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 Nome 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 attorney before co mmenci ng work or record 1n our Notice of Commencement.
natur of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License ho#der
STATE OF FLO IDA
STATE OF FLORIDA
COUNTY OF V(.LV
COUNTY OF P 01,L
Swor to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
VPhysical Presence or Online Notarization
this -2-G day of 2024 by
this 2-0 day of _ ' s l 202U by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification 'f
Personally Known V" OR Produced Identification
Type of Identification
Type of identification
Produced
Produced
(Signature of f otary blic- State of Florida)
(Signature 6fNotaPublic- State of Florida)
Commission Na ,b;cSbAJ ,e*id5
Commission No.
GomsaM Curswri mmn GG ME1852
Boni►ie Gornex
ommiswon GG 34MExpuea�$REVIEWS
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PLANS
VEGET
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REV€EW
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BATE
COMPLETED
Rev.5/6120
PLANNING & DEVELOPMENT SERVICES
- 13UILDING & ZONING DIVISION
2304 VIRGINIA AVE
WIN
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF TIC FOLLOWING:
V CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the .new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a $5O.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sum
Contractor.
CANCELLATION OF PERNUT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date; 04/19/2021
Site Address: 1 Z3 l Sr t s f- S-i-- .
Munna Contracting and Development Corp
Original GC, subcontractor or owner/builder
Jackson Construction Group, Inc
New GC, subcontractor
Reason for Cancellation UV O -L-
Permit Number: SLC 1906-0537
License CBC1258028 SLC License
License CGC1519160
SLC License
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractorlsu acto or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE O WNER (or ownerlbuilder) SIGN TLUFrGl L CONTRACTOR (or new GC, as applicable)
PRINT NAME Alexander Bussey
State of Florida, County of St. Lucie County
The following instrument was acknowledged before one this
19 day of April a0 29 by Alexander
Bussey Y who is personally known to me
or who has produced as L.
04119/2021
Signsturg F Notxty Date
Revised 04/15/IE
f90 Notary Pubk Sttee of Fbnde
Bonnie Gomez
My Commission GG 348952
�} Expires 06rzor2038
PRINT NAME Michael Jackson
State of Florida, County of St, Lucie County
The following instrument was acknmwledgotl before me this
s _day of J
202s by
Michael Jackson who is personally known to
th$owho
has produced as 1I7.
/� 04l1912021
Signa at 14o Date
evo YNQCWY Pubhc SCME oForda
I omezz
W COnmisoGG 34W52
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