HomeMy WebLinkAboutBuilding Permit ApplicationAWAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: POT Vq5
•
Building Permit Application
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 Residential X
PERMIT TYPE: New Construction
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Property Tax ID #: I'll 1- 10 0 - 0110 - 00 0, 1 Lot No._l�
Site Plan Name: _a G Mt H"0 m ,e S Block No. — —
Project Name: O d (A YY) S tt Q m ,f J b t N o v rh vV) s r 0" 1 0 Y1.01 GI I N
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Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
vv
r Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 3y g3 Sq. Ft. of First Floor: ppp
Cost of Construction: $ 3?za , 1 5 Utilities: x Sewer '—Septic Building Height:
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Name Adams Homes of Northwest Florida, Inc. Name: William Bryan Adams
Address:3000 Gulf Breeze Parkway Company: Adams Homes of Northwest Florida, Inc.
City: Gulf Breeze State: _ Address:3000 Gulf Breeze Parkway
Zip Code: 32563 Fax: City: Gulf Breeze State: FL
Phone No.772-905-8394 Zip Code: 32563 Fax: 772-905-8511
E-Mail: pslpermits@adamshomes.com Phone N0772-905-8394
Fill in fee simple Title Holder on next page ( if different E-Mail pslpermits@adamshomes.com
from the Owner listed above) State or County License CRC1330146
f value of constructinn is 47Snn nr mnrc n Qrrnoncn ni..«:.,...c r.I
— ____' _, _ ..___..___ ...na .a vcyuncu.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Not Applicable
Name: Keesee Associates
Address: 945 South Orange Blossom Trail
City: Apopka State: FL
Zip: 32703 Phone 407.880-2333
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:-
aelmo LIKelf1 J_1NA11
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
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-ownrertLessee/Contractor as Agent for Owner
Signature of Con ra t-or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF SaintLuoie
COUNTY OF SaintLucie
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this j94_ day of �,ftA JU 20Z)0by
this c91A day of Ju-PIR , 20�D by
� G r\J -RdG Y S
F)Yv a )�j OTC-1 C( ME
Name o eperson making statement.
Name ot person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary P lic- Stat o Florida)
(Signature of Notary Publi tate o FI rida )
Commission No. O I
1
(5,15 a0 ,,,.,, RiCHARD DOUGIACJDMMI4SSi
No.
e° +%''• Notary ? C,ii -Tale
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of Florida ; '; �; •.•• RIC!1ARD DOUG
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REVIEWS
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VEGETATION
SEATUR Rvt�
NITf�Cy'V'C` P irI
COUNTER
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REVIEW
REVIEW REVIEW
REVIE
R IhroughNa
DATE
RECEIVED
DATE
COMPLETED
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Rev. 2/7/ 19
Florida
2021