HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 7� J
Date: �� y� -� Permit Number: l •O�Lp
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Building Permit Application D o
Planning and Development Services 2zs
Building and Code,Regulation Division �R
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE: New Construction
PROPOSED IMPROVEMENT LQCATION
Address:531P 5 cSa n (?�.,LJC m'l M PL
Property Tax ID#: { I - l V'}" � '-1 ' 000 - L4 Lot No.�
Site Plan Name: Q im1 IO YI c Block No. S
Project Name: WCL MS M 1 tnY 1�. s 63 i�300 W& t FL , t C
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION`INFORMATION:
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Additional work to be performed under this permit-check all that apply:
J Mechanical _Gas Tank _Gas Piping _Shutters AWindows/Doors
Il Electric y Plumbing. _Sprinklers _Generator /per Roof Pitch
Total Sq. Ft of Construction:_ C7N ttuII ?)S
- 1Sq. Ft. of First Floor:
Cost of Construction:$ (J��� 6 `� Utilities: 1,Sewer _Septic Building Height:
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QWNER/LESSEE , CONTRACTOR:
Name Adams Homes of Northwest Florida, Inc. Name:William Bryan Adams .,
Address:3000 Gulf Breeze Parkway Company: Adams Homes of Northwest Florida, Inc.
City: Gulf Breeze State:_ Address:3000 Gulf Breeze Parkway
Zip Code: 32563 Fax: City: Gulf Breeze State: FL
Zip 32563
Phone No. � , -- p Code: - Fax: 772-905-8511
E-Mail:pslpermits@adamshomes.com Phone No772-905-8394
Fill in fee simple Title Holder'on next page(if different E-Mail Pslpermits@adamshomes.com
CRC1330146
from the Owner listed above) State or County License I�
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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SIJPPLEMENTA-L CONSTRUCTION LIEN LAW INFORMATION,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Keesee Associates Name:
Address:945 South Orange Blossom Trail Address:
City: Apopka State: F!_ City: State:
Zip: 32703 Phone407-880-2333Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 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."
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Signature of Owne /Contractor as Agent for Owner Signature of Contra ctor/Li—cense—H—otder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF saint Lucie COUNTY OF Saint Lucie
The fo oing instru ent was acknowledged before me The forgoing instru ent was acknowledged before me
this�day of 1 L 2007 by this day of R�X l L 20� by
,�Y4G 1Q WCA anAQ -5 V V ck w1 Cl G.YV1 S
Name of person making statement. Name of person making statement.
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of(dent' i tion Type of Identification
Produc Produced
(Signature of Notary Public-State of Florida) g g��} /v Si Notary Public-
F0.Y.°P'
PATRICIA NN GRIFFIN "'° PATRICIA ANN GMF 9
Commission No. GG137624 (fie G�: o. -•: :, M
r GG137624 = bMWISSION#GG13 6
;K MY COMMISSI q9 y§,At Q=
�•e �o�' EXPIRES Sep ember 26,2021 ''?gFF4o ' EXPIRES September 26,202
REVIEWS FRONT. ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19