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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: O�
Y ,
� RECEIVED
Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort,Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: New Construction
Address:) I I J R Y" Cj I E J Crry( �1
Property Tax ID #: 1511- l Do- D Q 1 b- O 1
Lot No._�
Site Plan Name: Y�dr'U�mm� f O Iv'i�l I ,1ST / �1 �1,, �n1 P 1 Block No. o9
Project Name: du m 11 Q 1 1 I I b f 1 V o I' 11' Iv i o t f l oy i OI Gl 9 (��
Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping
—Shutters Windows/Doors
r Electric Plumbing _ Sprinklers
_ Generator Roof Pitch
Total Sq. Ft of Construction: 3a i I
Sq. Ft. of First Floor: o25 I LP
Cost of Construction: $ 33-1 9-1 0 Utilities:
X Sewer _ septic Building Height:
; , y
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OOWNE y;r _ - -,wry x 10110
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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
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.
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DESIGNER/ENGINEER:
Name: Keesee Associates
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: 945 South Orange Blossom Tram
Address:
City: Apopka State: FL
Zip: 32703 Phone407.880-2333
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
Address:
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 Owner/ Lessee/Contractor as Agent for Owner Signature
STATE OF FLORIDA
COUNTY OF SaintLucie
STATE OF FLORIDA
COUNTY OF SaintLucie
/License. Holder
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this__") day of tJ LA AJ , 20 a Oby this _, day of J u ru , 20 a C)by
au G M ftd a YY� S F� ry G Vl Tcl Ct ME
Name olf person making statement. NameTn making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced
(Signature of Notary P lic- Stat o Florida )
Commission No. I (Se�(a;:,, • itn:HARODOU(
Notary P.,,Ijii�
.: rh ,t o1 • Co.
REVIEWS I FRONT ZONI
COUNTER REVII
DATE
RECEIVED
DATE
COMPLETED
WAFIAt M
Personally Known x OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pub(lli tate o FI rida )
tCofSpNssi No. 6 }
IG�8482ida i'r'� RICHARDDOUG OHNSOP
tal iFlorida
ar . ; . a, ; • Commission G 84821
VEGETATION I SEATU
REVIEW REVIE
Through
20, 2021