HomeMy WebLinkAboutBuilding Permit Applicationr
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (DA \� d Permit Number:
- — Building Permit Appli
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: New Construction - 5
—NUP
RECErV—E.D
JUN 18 2020
cie county, rmitting
Residential X
Address: q5M cy \s Y hI C F
�1 f�
Property Tax ID#: I311-100- o oy- ODV-0 Lot No. 07
Site Plan Name:/�0y d (A YYI S 1:"0 YYU S Block No. c9
Project Name: _� A M f H:iYU S 1) C 1 `t0 f t-h W Q - F (, d Y 1(:A Gi I i N c
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
r Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: _ Q5 Sk f
Cost of Construction: $ as u , 9 "c)
Name Adams Homes of Northwest Florida, Inc.
Address:3000 Gulf Breeze Parkway
City: Gulf Breeze State:
Zip Code: 32563
Phone No.772-905-8394
Sq. Ft. of First Floor: 19 ) K
Utilities: )LSewer —Septic Building Height:
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
I value of construction is $2500 or more, a RECORDED Notice of Commencement is
V1 r1VH1_ is ;,r,auu or more, a RtcDRDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name: Keesee Associates
MORTGAGE COMPANY: _
Name:
Not Applicable
Ad d ress: 945 South Orange Blossom Trail
Address:
City: Apopka State: FL
Zip; 32703 Phone407-880-2333
City:
Zip; Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not
Name:
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."
�Signature
Holder
€ewner/-Lessee/Contractor as Agent for Owner
Signature of Con ra Mr/License
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF saint Lucie
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of JIA.R..t , 20�by
this I O day of tIA n D , 20j�k Dby
UYvG►� 1�danns
► ry 0y\1 mcims
Name oV person making statement.
Name o person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
`btAmd IbA08 �—
Produced
R L�Ao,� Rrntn>�ad —
(Signature of Notary P iic- StOaatao Florida)
(Signature of Notary Publi tate o FI rida )
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�,� o� u u a i
Commission No. �+ r/1 (56�j�'9'•.. N�CHARDOOUG
SJORRMtsi No.
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Florida aa.....,�,a ;,• RICHARD DOUC
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DATE
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DATE
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Rev. 2/7/19