HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE -INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c(��
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��-- Building Permit Application' FED121o2o
Planning and Development Services permitting 42 Building and Cade Regulation Division St. Luele Capufont
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2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: New Construction
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Address: 60002 H t G1eof-" Dr.
Property Tax ID#: 3402 -(POq' 0(0t4q - 606- Lot No.
Site Plan Name: Adam S Roimc S Block No. 10
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Project Name: AelornS f%fyt-e S oP AloffhWeSf FLort�d Ott INC
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Additional work to be performed under this permit- check all that apply:
KMechanical _ Gas Tank _ Gas Piping _ Shutters X Windows/Doors
x Electric X Plumbing _ Sprinklers _ Generator k Roof Pitch
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Cost of Construction: $ 25$ i (S� Utilities: a er _Septic Buildingq Height:
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Name Adams Homes of Northwest Florida, Inc.
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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
Phone No:772-905-8394
Zip Code: 32563 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
State or County License CRC1330146
from the Owner listed above)
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: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name: KeeseeA sociates
Name:
Address: 945 South orange Blossom nail
Address:
City: Apopka. State: FL
City: State:
Zip: 32703 Phone407490-2333
Zip: 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 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."
as Agent for Owner
STATE OF FLORIDA
COUNTY OF SainlLeue
The forgoing instrument was acknowledged before me
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this day of S _� b , 2ta0 by
Signature of Contractor License Holder
STATE OF FLORIDA
CO U NTY O F saint Lena
The forgoing instrument was acknowledged before me
this I (( day of F�P_ b 20_1pby
Name of person making statement. I Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sign Ore of Notary Public- t!"
IvrRATRICIA ANN _
nature of Notary Public -State of Florida )
Commission No. cct3�eza
•': MY COMMISSION # GG7
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