HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to • --�)q •';>V Permit Number: IW -
-- Building Permit Application 1Uw 2 � 2020
Planning and Development Services
Building and Code Regulation Division c ftlrl=1 LJf=r�arf�rr'Ir-?
2300 Virginia Avenue, Fort Pierce FL 34982 JL• )--U i�t(� r�-CUrI�`� =(
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential `�--- County,
PERMIT TYPE: New Construction
Address:. �_�_ � GI 1 j ail Y
Property Tax lDM.I?1II' 1oD' 0 1 3 S - DD0- a Lot No.
Site Plan Name: �Itt a m s R-brn ji Block No. c�
Project Name: lA U i{ 1 t_ H b "YN, 5 19 � NO r ill N i ,f 1- T- It) v i M r•. i rV r
Additional work to be performed under this permit— check all that apply
Mechanical
_ Gas Tank _ Gas Piping
Shutters
A Windows/Doors
l
I Electric
1: Plumbing _ Sprinklers
_
_ Generator
K Roof
Total Sq. Ft of Construction:
_3Sq.
Ft. of First Floor: nl
al 1
Cost of Construction:
$ 32) 3 ,14 Q Ct 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
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)
Pitch
Name: William Bryan Adams
Company: Adams Homes of Northwest Florida, Inc.
Address:3000 Gulf Breeze Parkway
State: FL
Zip Code: 32563 Fax: 772-905-8511
Phone No772-905-8394
E-Mail pslpermits@adamshomes.com
State or County License CRC1330146
City: Gulf Breeze
f value of construction is S2500 or more. a RFrnanFn u.,nre . f r........e.......... __�
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: Keesee Associates
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 945 Scuth Orange Blossom Trail
Address:
City: ApopY State: FL
Zip: 32703 Phone407�880.2333
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 YnIIR 1 FNOFR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Tr Holder
Tgnature f-Own -Lessee/Contractor as Agent for Owner
Signature of onTor/License
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF sainllucle
COUNTY OF Saint Lucie
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this IO day of t)N- V .20CJJ)by
this AA day of\A.." .20_gD9:by
EmIGM ftday \S
l V-�G`Q mc{vNE
Name of 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
I( 1!'1y1011 DX rf,SMHXG� ✓/VOttwt�
nProduced
II AO• lA nn oSl rfJrnlOa.Q¢� �6•t1W�—
(Signature of NotaryP lii(c- Stoat o Florida)
(Signature of Notary Publi Late o FI rida I
Commission No. O V I (Se (J;,I,•.,,
No.
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No!ary?ccf!c-.
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Commssign
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REVIEW
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REVIE
REVIE REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 21711
2021