HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DateAa`$� a.2b Permit Number: _ a,CA a
Building Permit Applica ion
Planning and Development Services ST, Lucie County,
Building and Code Regulation Division permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: New Construction , S V �
Address: J 6H "1 6 L( V ( nt YI Z AX rrL
Property Tax ID #: 1 ' Oy o • boo
Site Plan Name: a ffi s
Project Name:
Lot No. 13
Block No. _
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters' Windows/Doors
Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: t tt�� 0 u Sq. Ft. of First Floor: ILA IVA
Cost of Construction: $ 1) t7 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 No 772-905-8394
E-Mail Pslpermits@adamshomes.com
State or County License CRC1330146
f value of construction is $2500 or more. a RECORDED NnticP of rnmmanrarnant ic ran, A: 4
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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g�.S�UpPLE
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: Keesee Associates
Name:
Add re ss: 945 South Orange Blossom Trail
Address:
City:
State:
City: Apopka State: FL
Zip: 32703 P h o n e 407-880-2333
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,.scre'en rooms and-accessory'dses 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."
Holder
Signature lavmer/ Lessee/Contractor as Agent for Owner
Signature of Con ra t-or/License
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF SaintLucia
The fQfgoing instru ent was acknowledg d before me
"6.Q
The fo; going instrument was acknowledged before me
4 C by
this day of C 20 by
this day of 20�
5Y \I G ry -P-d Ck Y S
1 ry CA )l cl CA M S
Name o 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- St�a[t o Florida)
(Signature of Notary Publi tate o1 FI rida )
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No.
Commission No. V► u (Se lf';,,'; RiCHARDDOUG
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Noiory Rcbc-.
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DATE
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DATE
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Rev. 2/7/ 19
Florida
is Nlr 20, 2021