HomeMy WebLinkAboutBuilding Permit ApplicationIII
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: -1 � 1 C.1 and Permit Number: 007 i " Z ! (� `/ 1%
-- --— Building Permit Applica ion JUL 16 2020
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPE: New Construction
Address: h d 1.1 1�1(Yl U I i 1
Property Tax ID #:
Site Plan Name: -No 1 1 vtI f' t
Project Name: qd(A h1/`"
Elm
Additional work to be performed under this permit- check all that apply:
Lot No.R_
Block No. a2
v Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
r
_ Electric _�t Plumbing L` mbing _ Sprinklers _ Generator Roof Pitch
ry
Total Sq. Ft of Construction: �A c� 5 Sq. Ft. of First Floor: 11 � P D
Cost of Construction: $ a7l Cl . 5LA 6 Utilities: ISewer _ 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 S2500 or more. a RFCORnFn Nnriro of r,.,.....o...e.,.e...:........:...�
If value of HVAC is $7,500 or m re, a RECORDED Notice of Commencement is required.
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StIJPP,<L MENT;"AL C�ONSeTRUCTION LIF��I I>AW INFORM/
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DESIGNER/ENGINEER: _ Not Applicable
Name: KaesaeA socialas
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 945 South Orange Blossom Trap
Address:
City: Apopka 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature f GwnerJ-Lessee/Contractor as Agent for Owner
Signature of Con ra tar/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF Saint Lucia
The for oing instrument was acknowledg before me
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The for oing instrument was acknowledged before me
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this day of MC 1 by
this day of M GT 20rit>by
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Name�rson making statement.
Name oV person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
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Produced
IL tP A a t RJ X apa" I
(Signature of Notaryliic-StCa/t�10 Florida)
(Signature of Notary Publi Late o FI rida I
Commission No. Vr O u 0 01 I (Se�lj;,�•.,,
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DATE
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COMPLETED
ev.2/1/19