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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �� O� •0 . aJ
gu LUC UIE AMMVED
2 3 2021
p . Building Permit Application 6t, Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: New Construction -.Single Family Residence
PROPOSED- IMRROVEMENT LOCATION
Address: %D ®� �p,L�T �A'L/�/1 r/ I�✓ /'7` /�J
Property Tax ID #: /39/ - c!r/� r ��qd - �yblU —� ' Lot No.
Site Plan Name: WJH FL LLC - Wade Jurney Homes Block No.
Project Name: Lakewood Park
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _ Pond
N/lectric VAlumbingp _Sprinklers _Generator Roof Pitch
<TotatkSq Construction: �~ qq;-Ft: GERFirstAgAr: �T
cost'em.onsfructia�$ Utilities: —Sewer _Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name WJH FL LLC- Morey Doyle
Name: nray noyiP
Address: 3091 Governors Lake Dr Suite 300
Company: WJH FL LLC -Wade Jurney Homes
Address: 3091 Governors Lake Dr Suite 300
City: Norcross State: GA
Zip Code: 30071 Fax:
City: Norcross State: GA
Phone No. (321) 270-6629
Zip Code: 30071 Fax:
E-Mail: Heather.Dahlin@CenturyCommunities.com
Phone No (321) 270-6629
E-Mail Heather.Dahlin@CenturyCommunities.com
Fill in fee simple Title Holder on next page (if different
State or County License rrr,I5174.r,R
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,506 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: FDS Engineerinq Associates
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address: 258 Southhall Lane, Suite 200
City: Maitland State: FL
Zip: 32751 Phone (321) 972-0491 ,
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 attorney before commencing work or recording your Notice of Commencement.
(1�
Signature of Owner/ Les a/Co tractor as Agent for Owner
STATE OF FLORID n
COUNTY OF YrZI�Ct-/�
Swore�}} (or affirme and subscribed before me of _
this !dayof _ 20 by
Physical Presence or
Online Notarization
"WoV_4'fP" "WW�
Name of per` n malewfg tement.
Personal) Known OR Produced Identification
Y
Type of Identification Produced
(SignafurtoT 116tary Public- State of Florida )
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N=Dahlin
of Florida)H(SealM029010' E
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Rev 5/20/21