HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ust 110 Permit Number:
r'vw"'Im M11—!:
COUNTY
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
T
53 N
Address:
Property Tax ID Lot No. U
Site Plan Name: Block No.
Project Name: ort
fqc.
Additional work to be performed under this permit— check all that apply:
'Mechanical Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator _1K Roof Pitch
Total Sq. Ft of Construction: U q Sq. Ft. of First Floor:
Cost of Construction: $ 'Zp I 9 Utilities: 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 psipermits@adamshomes.com
from the Owner listed above) State or County License CRC1 330146
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: _ Not Applicable
Name: Keesee Associates
Address: 945 South Orange Blossom Trail
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: Apopka State: FL
Zip. 32703 Phone407-880-2333
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
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-OwniEr/ Lessee/Contractor as Agent for Owner Signature of
STATE OF FLORIDA
COUNTY OF Saint Lucie
STATE OF FLORIDA
COUNTY OF Saint Lucie
/License. Holder
The f rgoing instru Sept was acknowledge before me The forgoing instru ent w s acknowledged before me
this Q1 day of 20 by this day of 20 by
,UY G t\J ftd a YY� S 'P) Y\i a l T-cl Cl M S
Name ot person making statement. Name— o 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- Stoat o Florida) (Signature of Notary Publi tate o FI rida )
Commission No. O� 0 I ($e lf'.,'; •.,, RiCH RDDOUG fjom ONssi No.
No!ary R.zliC -,tale
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