HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE romps FTFn FnR naai irnTIM Tn RF arrrDTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number: 1y I
Building Permit Application
PERMIT TYPE: New Construction
Commercial Residential X
Address: U I U rYI X V a Y I O 4j(\) =�
Property Tax ID #: ' 1 - 0 01 a ' o Q 0 - Lot No. 314
Site Plan Name: --fi a (k Block No. 0
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Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric Plumbing _ Sprinklers _ Generator j Roof Pitch
Total Sq. Ft of Construction: '3063 Sq. Ft. of First Floor:y) O y
Cost of Construction: $ 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 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
.. .�.�. a. v. .. V. 1 a aI Vb%IV I ID �JG7VU U1 AA IUIt, d nmunutu ivotice or Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: Keesee Associates
Name:
Address:
Address: gas south Orange Blossom Trail
City: State:
City: Apopka State: FL
Zip: 32703 Phone407-Sao-2333
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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-ov nlW Lessee/Contractor as Agent for Owner
Signature of Con ra or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF saint Lucie
COUNTY OF saintLucie
The forgoing instru ent was acknowledged before me
this day of, 2070by
The forgoing instrume It was acknowledged before me
this day ofi u 20_Z Dby
byv G ry -I da rrn S
�Yy CA �
Name 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- Stat o Florida ).
(Signature of Notary Pub(lli tate of FI rida )
o
Commission No. O I
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0 (Se lf';,,'; •. Ri:HARDD000
COfflS0Nssi No. 6 (
r�r �" 1 0 , Notary ?ehii� -,
late of Florida ; 'P• RICHARD DOUG
• . �h� .a • Com:m;ssion ft
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REVIEWS
FRONT
ZONI �
I r' i yiionatJWNVEGETATION
SEA TUR y ,�
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COUNTER
REVIE
REVIEW
REVIEW REVIEW
REVIE
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19
Florida
2021