HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED nn cr-7
Date: Permit Number:
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-- �- Building Permit Application '
Planning and Development Services u�ue1U20 anent
Building and Code Regulation Division Permitting Depagpkt
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPE: New Construction
Address:
Property Tax ID #:
Site Plan Name: V
Project Name:
Lot No.��
Block No. a
Additional work to be performed under this permit —check all that apply:
'Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 071 na a Sq. Ft. of First Floor: of a
Cost of Construction: $ i�I Utilities: )LSewer —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-M a i I: Pslpermits@adamshomes.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
f value of construction is
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
or more. a RECORnFD Nntirp of fnmmpnrpmpnt .....,;,.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: xeeseeAssociares
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 905 SaWh O.q.9loaso.'r.11
Address:
City: Apopka State: FL
Zip; 32703 Phone^07.ee0-2333
City: State:
Zip: 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."
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'Sign
ature fever er/-Lessee/Contractor as Agent for Owner
Signature of Con ra Cor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF Saint Lucie
The for Ding instrument was acknowledged before me
iGby
The for Ding instrument was acknowledged before me
this day of QV 20_f
this day of 1(Yl G�4 20dD 6y
Uyv G r�j ftda M S
Ryv G V,,j +�d Ct ME
NameTn 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
PPrrod�u/c�ed�
IC.U.:V Ud'I DX rf.XMIbYGtL ✓/yJ171+i1��
Produced
AP Qn OS! � �C,Vd i
(Signature of Notary lic- StCa/t o Florida)
(Signature of Notary Publi&4tate FI rida )
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Commission No. V1O o I (Sp�(a;�•.,
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ACOFASOWiCNo.
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of Florida ,.�a;t;g��,. RIDIARD00110
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DATE
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DATE
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Rev. 217119