HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
PERMITTYPE: New Construction
Address:
I
Commercial Residential X
Property Tax ID#: NI- IDD- 010%- Lot No. t'I
Site Plan Name: -Ddoms tioM (s 1 r�L r Block No. a
Project Name: fid Cl(/{�I t f n VYI ( f ( 1 nq V O Y r h W) c 1 T I 0 V 10 CA Q C
Additional work to be performed under this permit— check all that Mapply:
/'echanical _ Gas Tank _ Gas Piping _ Shutters %� Windows/Doors
I` Electric Plumbing _Sprinklers _Generator �1L' Roof Pitch
Total Sq. Ft of Construction: 300D Sq. Ft. of First Floor: gal $ I
Cost of Construction: $ 3b 1. OI Do Utilities: X. Sewer _Septic Building Height:
Name Adams Homes of Northwest Florida, Inc.
Address:3000 Gulf Breeze Parkway
City: Gulf Breeze State: _
Zip Code: 32563 Fax:
Phone No.772-905-8394
E-Mail: pslpermits@adamshomes.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: William Bryan Adams
Company: Adams Homes of Northwest Florida, Inc.
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
State or County License CRC1330146
f value of construction is $2500 or more. a RECORDED Nntfrp of .n..,,6-A
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name: Keasee Associates
MORTGAGE
Name:
COMPANY: _ Not Applicable
Address: gas South orange Blossom well
Address:
City: APePka State: FL
Zip: 32703 Phone4grA90.2333
City:
Zip:
State:
Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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."
signature -Lessee/Contractor Agent for Owner
Signature of Con ra £or/License Holder
as
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sain[Lucie
COUNTY OF Saint Lucie
The forgoing instrument was acknowledged before me
The for Ding instrument was acknowledged before me
Ju•kk
this �day of (IUr.P .20�by
this day of ,20dOby
BY\I G N ftd a YYA S
1 Yv Q)�j IlAd G m 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 Identification
Type of Identification
Produced
Tz.LcIh�,DP .•Pad �--
Produced
R.�A � 5J �� ��—
(Signature of NotaryP lic- StCa/t o Florida)
(Signature of Notary Publi tate o FI rida )
Commission No. A I (Sella
No. I
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Way Pu7iic-.Ialeof
Florida """ RICHARG GOUG
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