HomeMy WebLinkAboutBuilding Permit ApplicationAll~APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - �� (� d'0 Permit Number: 10 D l - fig 5q
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- 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
PROP`rSED MPRO'1/EMENT'iL00. Aa "
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Address: p lh I n NI A If 0 G I K
Property Tax ID #: I I- 1 0 U- 61 a y- 0 - U Lot No.��
Site Plan Name: /D/dm,1 11 .0-- 'NO iTh W,II V R 0 V( Block No.
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Project Name: lit l ,C1 ins
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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: aj401Q;Q, Sq. Ft. of First Floor: 09,91
Cost of Construction: $130� GID Q Utilities: k 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 No772-905-8394
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 constructinn is 0;nn nr mnro n PrrnDncn him.;..- ..c r...... .._ ___.
- - --- --- .may... u.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: Keesee Associates
Name:
Ad d re s s : 945 South Orange Blossom Trail
Address:
City: Apopka State: FL
City: State:
Zip: 32703 Phone407-880-2333
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, 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."
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Signature f-ovdrrer/ Lessee/Contractor as Agent for Owner Signature of Confr-a-c1ror/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Saintt.ucie COUNTY OF Saintl,ucie
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this � day of 2Q�o by this .- day of Q LkA � 20ODby
au a ►\J -RCA rnn.S F)rN a � �Acl c�yy1S
Name ot person making statement. Nameoeperson making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced
kxa" 2e� -
(Signature of Notary
P lic- St�a/tao Florida )
Commission No. V' O D U1 I (Ss5i)' Ri(11H RD—D0
r s c• Notary P:JIIC—�
REVIEWS I FRONT I ZON
COUNTER REVI
DATE
RECEIVED
DATE
COMPLETED
Personally Known x
Type of Identification
Produced
OR Produced Identification
(Signature of Notary Publi tate o FI rida )
If,gffl pNssi No.
Florida
VEGETATION I SEA TU
REVIEW REVIE
RICHARD DOUG Al Of Florida
HNSON
Commission G @4121
��EExpir s jr,20,2021
ItuouahNaion lwyksn.