HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: kbu—
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.
Address: V, 1 1M G�I I1 C J V
Property Tax ID #: 13 1 1 1 - 1 Lot No. 3 0
Site Plan Name: -Rd o m s } h m .{ s Block No. a
Project Name: _ �U M S H-0 ►rn t S Of NO-T M-yI IS V T 10 r1 0161 1 N
I'00Y" f
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: 35 Z' Sq. Ft. of First Floor: 3
Cost of Construction: $ 33 $1 —1 Utilities: )�_ Sewer _ Septic Building Height:
Name Adams Homes of Northwest Florida, Inc.
Name
Address:3000 Gulf Breeze Parkway
Comp
City: Gulf Breeze State: _
Addre
Zip Code: 32563 Fax:
City: i
Phone No. 772-905-8394
Zip Cc
E-Mail: pslpermits@adamshomes.com
Phonc
Fill in fee simple Title Holder on next page ( if different
E-Mai
from the Owner listed above)
State
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• William Bryan Adams
any: Adams Homes of Northwest Florida, Inc.
ss:3000 Gulf Breeze Parkway
3ulf Breeze State: FL
de: 32563 Fax: 772-905-8511
N o 772-905-8394
Pslpermits@adamshomes.com
)r County License CRC1330146
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
i
4
DESIGNER/ENGINEER: _ Not Applicable
Name: Keesee Associates
MORTGAGE COMPANY: Not Applicable
Name:
Address: 945 South Orange Blossom Trail
Address:
City: Apopka State: FL
Zip: 32703 Ph one407-a90-2333
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."
Holder
Signature flvdrmr/ Lessee/Contractor as Agent for Owner
Signature of Con ra t-or/License
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF SaintLuale
The forgoing instru ent was acknowledged before me
The forgoing instrument was acknowledged before me
this 10 day of 20�Ibby
this k1D day of tJ X,Q 20_aDy
5r � G Y�J -Rd a � S
� ry a y�l TT c� M S
Name o person 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- Statkoj Florida)
(Signature of Notary Publi tate o FI rida )
Commission No. 0 u 0 I (Se (a;;,;•.,
No. l I
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/1/ 19
Florida
s Nlr 20, 2021