HomeMy WebLinkAboutPERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Planning and Development Services
Permit Number:
Building Permit Application
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
PERMIT APPLICATION FOR:SFR NEW CONSTRUCTION
PROPOSED IMPROVEMENT LOCATION:
Address: 9605 S INDIAN RIVER DR
Property Tax ID #: 3519-444-0005-000-1
Site Plan Name:
Project Name: KASSAWAT RESIDENCE
DETAILED DESCRIPTION OF WORK:
SFR NEW CONSTRUCTION CBS 4 BEDROOM, 3 BATH 3 CAR GARAGE
New Electrical Meter X Second Electrical Meter
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additignal work to be performed under this permit —check all that apply: /
_Mechanical _Gas Tank _Gas Piping _Shutters _✓Windows/Doors _Pond
Electric ✓lumbing _Sprinklers _Generator ZRoof Pitch
Total Sq. Ft of Construction: 4,027 Sq. Ft. of First Floor: 4,027
Cost of Construction: $ 489,291 Utilities: —Sewer Septic Building Height: 22_
OWNER/LESSEE:
CONTRACTOR:
NameMUHANNAD KASSAWAT
Name:JEFF ALEXANDER
Address:4203 NE SKYLINE DR
Company:HOMECRETE HOMES INC
City: JENSEN BEACH State:
Zip Code: 34957 Fax:
Phone No.772-873-6707
Address:2162 NW RESERVE PARK TR
City: PORT ST LUCIE State: FL
Zip Code: 34986 Fax:
PhoneN0772-873-6707
E-Mail:MSHOWMAN@HOMECRETEHOMES.COM
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailJALEXANDER@HOMECRETEHOMES.COM
State or County License CGC1513746
If value of construction is 2500 or more, a RECORDED 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: BRADEN 6 BRADEN NA
MORTGAGE COMPANY: x Not Applicable
Name:
Address:417 BE COCONUT AVE
Address:
City: STUART State: FL
Zip:34996 Phonem-2amzaa
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x Not Applicable
Name:
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 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 work or recording vour Notice of Commencement.
email � C%I G�
Signatur O ner/ Lessee/Contractor as Agent for Owner Signatur o ontractor/Li ense Holder
STATE OF FLORI A STATE OF FLORI A
COUNTY OF �-t 111P.1 t'. COUNTY OF , j�lJ k22.
Sworn to (or affirmed) and subscribed before me of Swor to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization Physical Presence or_ Online Notarization
this_ day of. 2020 by this _ day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Public-;
Commission No.
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
&rgfTl'GCRJFubllcState ofFlorida
(Signature of Notary Publi
Melleaa D Showman
pp((��[[�piyynnlaelon GG 294495
ommission No.
1,61, Ekp'nes'01124/2023
ry`s�
ZONING
SUPERVISOR
PLANS
VEGETATION
REVIEW
REVIEW
REVIEW
REVIEW
SEA TU RTLE
REVIEW
Public State of Florida
a D Showman
a lr iaaion GG 294495
MANGROVE
REVIEW