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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: _� �}' Permit Number: "`
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-- -- -. Building Permit Application NOV'24:2020
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 Cjp CoU ntyt K
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial esir�
PERMIT TYPE: New Construction
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Address: V3li U (,� Q S�
Property Tax ID #:13
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Site Plan Name: T7
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Project Name: Ran
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Additional work to be performed under this permit— check all that apply:
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Mechanical _ Gas Tank _ Gas Piping _ Shutters!' A Windows/Doors `
Electric Plumbing _ Sprinklers _ Generat Roof Pitch
for
Total Sq. Ft of Constructio/n�:/i900 3 Sq. Ft. of First Floor:, ZQQq
UunueS: -1,%-)ewer _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 I Fax: 772-905-8511
Phone No772-905-8394
E-Mail pslpermits@adamshomes.com
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. I
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: Keesee Associates
Name:
Address: 945 South orange Blossom Trail
Address:
City:, Apopka State: FL
"City: State:
Zip: 32703 Phone 407-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 subjectstructure
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 l 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 usesto 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 f-Owrrer/ Lessee/Contractor as Agent for Owner
Signature of Con ra Cor/License
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF SaintLueie
The foaoing instrumentwas cknowledged before me
The forgoing instrument was acknowledged before me
7.Dby
this � day of 2010 by
this 11 day of t-.% OV 20
au C1 � -Rda inn S
L�ry aj � � M
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
L&.,d
Produced
IL, —
(Signature of Notary P liic- Stoat o Florida)
(Signature of Notary Publi tate of FI rida )
Commission No. O u D I
VI (Se�1�;;,;,., Fr„iARDQOUG
C20fflmO ssi No. I
Noiafy R.,tik -,
iale of Florida ;, '; ' • RICHARQ DOUG
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G 084821 ; Notary Biblir
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
Florida
is Nilr 20, 2021