HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o-�.� Permit Number: rn u,,3,4
Building Permit ApplicatiorfiICENED
Planning and Development Services APR at 7070
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 PermittingDepartment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residelit iakoy,ty
PERMITTYPE: NEW Construction I
Address:
Property Tax ID #:
Site Plan Name: I
Project Name: -H
CONS ;'RUCTI,ONIINFORMATI'ON:,'r
Yth W
Lot No. 0113
Block No. a
Additional work to be performed under this permit —check all that apply:
XMechanical _Gas Tank' _Gas Piping _Shutters A Windows/Doors
Electric %Plumbing _Sprinklers _Generator n �Xy Roof Pitch
Total Sq. Ft of Construction: 7 QD aD Sq. Ft. of First Floor:
Cost of Construction: $ 30 5, 500 Utilities: �— Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:.
Name Adams Homes of Northwest Florida; Inc.
Name: William Bryan Adams
3000 Gulf Breeze Parkway
Address: Y
Company: Adams Homes of Northwest Florida, Inc.
City: Gulf Breeze' State: _
Zip Code: 32563, Fax:
Phone No.7727905-d394
Address:3000 Gulf, Breeze Parkway
City: Gulf Breeze State: FL
Zip Code: 32563 Fax: 772-905-8511
Phone No772-905-8394
E-Mail: pslpermits@adamshomes.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail pslpermits@adamshomes.com
State or County License CRC1330146
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.
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DESIGNER/ENGINEER: _
Name: Keesee Associates
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: 845 South Orange Blossom Trail
Address:
City: Apopka
Zip: 32703 Phone407-880-2333
State: FL
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE'RECORDING YOUR NOTICE OF COMMENCEMENT."
Sig ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lude
COUNTY OF Saint Lucie
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _LQ1 day of ici'D_r-rIL_ .20,aDby
this J_Qday of iirtl- .20AOby
R)nlct n Meams
gry Ck r\ W d C LY\AS
Name df person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identifi
Type of Identification
Produced
Produced
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lgnature of Notary Public- State of Flori
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Commission No. G0137624
EXPIRES S
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F-I EXPIRES September26, 2
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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