HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONtkA
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %� / n Permit Number: 1p
po RECEIVED
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Building Permit Application np-
arming and Development Services
Building and Code Regulation Division
-2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION- FOR: Building
PROPOSED IMPROVEMENT LOCATION:
Address: `�- a1 _ I.
17 1017
PERMITTING
Commercial St' L 1
Residential `� Q Ccun+,,. h,
Legal Description: CREEKSIDE PLAT NO. 1 (PB 55-12) LOT
Cr( C
Property Tax ID #: 2326-600- C00,B
Site Plan Name:
Project Name:
Setbacks Front ` Back: _ Right Side: 1 Left Side: -�
DETAILED DESCRIPTION OF WORK:
Construction for new Single Family Residence
N
CONSTRUCTION INFORMATION:
Neifll
O✓ HVAC Gas Tank ❑Gas P
Electric 0 Plumbing 2]Sprin
Total Sq. Ft of Construction:
Cost of Construction: $ t3A_I_
�4
Z
Lot No._a_
Block No.
ing UShutters windows/Doors
ers Generator Z✓ Roof Roof pitch
S Ft. of First Floor: i L
Utilities:'2Sewer Septic Building Height:
OWNER/LESSEE:
�-- CONTRACTOR:
Name D.R. Horton
Name: Brian W. Davidson
Address:1430 Culver Drive NE
CD.R. Horton Company
City: Palm Bay State: FL Address: 1430 Culver Drive NE
Zip Code: 32907 Fax: 321-733-7092 City:Palm Bay
Phone No: 321-733-2111 State: FL
Zip Code: 32907 Fax: 321-733-7092
E-Mail: Melboumepermitting@DRHorton.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 $2110 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not Applicable
Name: AB Design Group Inc.
Address: 1441 N. Ronald Reagan Blvd,
City: Longwood State: FL
327.50 - Phone: 407.4"07a
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: —
Address:
City:
ZIP: ___ Phone:
MORTGAGE COMPANY: Name: Not Applicable
Address:
City- State:
ZIP: Phone:
BONDING COMPANY:
Name: _Not Applicable
Address:
City:
Zip: Phone:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attornev ht-fnro
commencing work or recordineyour Notice of Co—
Signatu�OfOwrlerlLesse�elContra�ctorasent forwner AgO
STATE OF FLORIDA
COUNTY OF Bra+aid
The forgoing instrument was acknowledged before me
this 96 dayof December 2017 by
Q% 466a, L,"
(Name of person acknowledging)
I
{Signature Ot Notary
yPyublic- State of Florida )
Personally Known 0( OR Produced Identification
Type of Identification Produced
Commission No.t},h"h�,l'tP�`
otP°� °kvr �fQotary public State of
? t : Sandra Leone
Revised 07/15/2014 �' o rjul' Expires 08/10/2020
_ a-.iA- Aa A- -. 1 1 .
REVIEWS FRONT I ZONING
COUNTER REVIEW
INITIALS
sa�sv,s�r -
Si nature of �Ontrarct�®r//,License Holder 5
STATE OF FLORIDA
COUNTY OF sr,,,;
The forgoing instrument was acknowledged before me
this 26 day of December 20 17 by
(Name of person acknowledging )
(Sign— attire of Notary Public- State of Florida )
Personally Known �— OR Produced Identification
Type of Identification Produced
No. Y-e �.,e .
fi.1J11'�4i;f;-tarYPUblic Sate of
Sardra Leone
,_ ea bty Commission GG 0
SUPERVISOR I PLANS VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW
REVIEW REVIEW
WHEREAS, Applicant acknowledges that Applicant's negligence, or negligence on
the part of any of the Applicant' s sub -contractors, to exercise every reasonable precaution
possible to protect the integrity of Improvements will cause Applicant's current and fu
At Risk Permit privileges to be revoked; and ture
WHEREAS, a nonrefundable processing fee is submitted herewith; and
WHEREAS, infrastructure bonds were previously submitted and accepted by the
County;
NOW, THEREFORE, Applicant hereby acknowledges:
1• The above recitals are true and correct and are incorporated he by this
reference.
2. Applicant hereby agrees to hold County, its agents, employees and affiliates,
harmless from any and all manner of actions, causes of action, suits, damages,
judgments, executions, claims for personal injury or property damage, demands
or losses of any kind whatsoever, in law or in equity, which may arise as a result
of Applicant's commencement of construction prior to the completion of the
Improvements, including, but not limited to, losses from the loss of
workmanship and materials due to fire or other disasters whether manmade or
natural, and/or losses due to delays in obtaining a final certificate of occupancy
resulting in part or all from the failure to complete some or all of the
Improvements.
3. Applicant agrees to strictly follow the requirements set forth in the County's
Pilot Program Builder's At Risk Permit Policy dated September 21, 2016,
4. Applicant acknowledges that a water meter will not be installed for the subject
property until the St. Lucie County Utility Department (SLCUD) has issued a
letter of acceptance.
S• Applicant shall be responsible for the cost of any damages to County facilities
occurring as -a result of the issuance of building permits pursuant to this
Acknowledgement for one year after the issuance of a Certificate of Occupancy
(CO). The j: tk will submit an itemized statement to the Applicant
immediately after the damages are recognized.
6• Applicant agrees to remove any subcontractor or contractor on the project who
is determined by the County to be negligent in regards to the Improvements on site
and who continues to damage or destroy the Improvements which jeopardize the
health, safety and welfare of the citizens.
7. Applicant agrees to immediately cease construction of the home and
construction -related activities upon the County, as specified by Code, provides
a notice to cease work.
8• Applicant shall not transfer ownership of the home or unit until a CO is issued.
Page 2 of 3
9. Applicant shall record this '`Builder's At Risk Permit Acknowledgement" form
in the Public Records of St. Lucie County, Florida, at their own expense and
provide a copy of the same to the County.
IN WITNESS WHEREOF, Applicant has executed this Acknowledgment on the date
indicated below. /
For Applicant By: (printed name) Signature Date
STATE OF FLORIDA
County of: St -Lucie County
The fore-oin- instrument was acknowledged before me this
day of Qe—C_ 20_�
of
Said person 9 personally known to me. or
Notary Public
=oapr P"%. Notanl public State of Florida
11 Sandra Leone
my commission GG 020251
e 1
Expires 0811012020
For County Use:
Public Works Department
[produced other identification. to wit:
san�f�a Leo�te
Print Name
0 Fee Submitted Request Approved ❑ Request Denied
Comments:
Printed Name
Signature
Date
Utility Systems Department
❑ Fee Submitted Request Approved 0 Request Denied
Comments:
Printed Name Signature Date
Page 3 of 3