HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Z0�/ram_ I(,, ' —1 (;
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RECEIVED
SEP 101020
- - - Building Permit Applica'L'ucle County, Permitting
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
PERMITTYPE: NeW Construction
Site Plan Name: Block No.
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Project Name:y�* f 1 h �C i' 1. N C
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Additional work to be performed under this permit— check all that apply:
Mechanical —Gas: Tank _ Gas Piping _ Shutters Windows/Doors
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(` Electric Plumbing _ Sprinklers _ Generator _1K Roof Pitch
Total Sq. Ft of Construction: 2 5 Z Sq.Ft. of First Floor: 2 0
Cost of Construction: $ V 2 .
Utilities: (% Sewer SPntir Ruilriina uoiah+-
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Name Adams Homes of Northwest Florida, Inc.
Name: William Bryan Adams
Address:3000 Gulf Breeze Parkway
City: Gulf Breeze State: _
Zip Code: 32563 Fax:
Phone No. 772-905-8394
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 No 772-905-8394
E-Mail psipermits@adamshomes.com
E-Mail: psipermits@adamshomes.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License CRC1330146
vogue of conxruc❑vn is .?c5uu 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: _Not Applicable
Name; KeeseeAssociates
MORTGAGE COMPANY:
Name:
_Not Applicable
Address: s4sSeurhorangeSiossemTraii
City: Apopka State: FL
Zip:32703 P h o n e 407-880-2333
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 ewrrer/ Lessee/Contractor as Agent for Owner
Signature of Con ra t-or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF SainrLude
COUNTY OF SaintLucie
The f r oing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this day of a u a ��t, 202 (� by
this day of CIU- a U S- , 20LOby
au o fk-d CA YY1 S
1")rN G VQ v"-Tcl Ct ME
Name o p—erson .making statement.
Name ot person making statement. d
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Ryci�lf
Produced
LA"
(Signature of Notary P lic- Stoat o Florida)
(Signature of Notary Publi tate o FI rida )
Commission No. O 0 I (Se
No. 1
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
Florida
is Nlr 20, 2021