HomeMy WebLinkAboutBuilding Permit Application1,
All APPLICABLE INFO MUST BE COMPLETED FOR hPPLICATION TO BE ACCEPTED
Date: N r�
Permit Number: I � � QA,- S4
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT TYPE:
Address:
Property Tax ID it:
RLCENED
Building Permit Application DEC 1•i 1019
Permitting DepartMent
St. Lucie County
Commercial Residential X
i
Site Plan Name:
'r Lot No.lq&
naoiuonal work to be performed under this per t — check all that apply:'
_!Mechanical Gas Tank
/ as Piping _ Shutters
'� Electric ✓Plumbing, prinklers
_ G�nerator
Total Sq. F[ of Construction —1/Q
Sq. Ft. of First Floor:
Cost of Construction: $ c=07—V yy,_ 00
Utilities: ewer
NameAdams Homes of Northwest Florida, Inc.
Address:3000 Gulf Breeze Parkway
City: Gulf Breeze
32563 State:
Fax: _
Zip Code: 772-905-8511
Phone No.772-905-8394
E-Mail: Pslpermils@adamshomes.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Wi
Company
Address:
City: Gulf
Zip Code:
Phone No
E-Mail Psll
State or C
If value of construction is $2500 or more, a RECORDED Notice of Commencer
If value of HVAC is $7,500 or more, a RECORDED Notice Of Commencement is
Windows/Doors
Roof Pitch
_ Septic Building Height:
�I
Adams - Qualifier
omes of Northwest Florida, Inc.
Breeze Parkway
Fax: _
?-,90,$-8394
i(ts@adamshomes.com
ty License CRC1330146
State: FL
r�
Name: Keesee Ass IIWa s ArchltnW,e Design. Planning rr
Address: 945 apulh Orange Blossom Trail
City: Apopka State:
Zip; av0a FL
Phone4or-t 80-2304
FEE SIMPLE TITLE HOLDER:
0
Zip:
MORTGAGE Not COMPANY:
Name: Applicable y
Address:
City: State:
Zip: Phone:
Applicable BONDING COMPANY:
Name:
Address:
Zip: Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noworkwork or installation has commenced prior to the issuance of a permit.
which is n conflicmakes
with any applicablelon HomeaOwners Assoclatl permit will bylaws or andpcovenantss that malyrestrictbor 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."
as Agent for Owner
STATE OF FLORPASTATE OF FLORjQA
COUNTY OF_ of �iCOUNTY OFF Qlq.,
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �n_hC/ , 20A by this Al day of all
r�UuP/ 20� by
lui nC�S
h— mp of person ma in statement. at✓ts
Name rson makin�statement.
Perso_ nall�Kg n_A**" OR Produced Identification
Type of Identification all Kno n ✓ OR Produced Identification
Produced Type of Identification
(Signature of Notary Public- State of Florida) h�enetur„r
n�/��� . ®l iuo[ary Public•S of..
on N 1
Commissi/•,•e..a•,
";(S@i1jTRICIA ANN G IFCFIN A ;1! • • • PATRICIA ANN GRI
o Ission =Z - &MISSION # GG1
MY COMMISSION # G 7376m1
.c ber2 ,2021;'r EXPIRES September 26,
REVIEWS FRONT SOR PLANS VEGETATION COUNTER REVIEW REVIEW REVIEW REVIEW SEA TURTLE MANGROVE
DATE REVIEW REVIEW I