HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number: lil (S Z ^ V o2��
RECEIVED
Building Permit Application FEB 1
2021
Permitting Department
St. Lucie County
Commercial Residential X
PERMIT TYPE: New Construction
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Property Tax ID #:
Site Plan Name: k
Project Name: A
Additional work to be performed under this permit — check all that apply:
X Mechanical_/ Gas Tank _ Gas Piping _ Shutters
y` Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: :�ob_]!) Sq. Ft. of First Floor: _
�S
0
Lot No. Z.Z.•
Block No.
Windows/Doors
XX Roof Pitch
�a a y
Cost of Construction: $ 2_
L&2 Utilities: P 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: _
Zip Code: 32563 Fax:
Phone No. 772-905-8394
Address:3000 Gulf Breeze Parkway
City: Gulf Breeze State: FL
Zip Code: 32563 Fax: 772-905-8511
Phone No772-905-8394
E-Mail: psipermits@adamshomes.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail pslpermits@adamshomes.com
State or County License CRC1330146
li Value oT Construction Is :�ZSUU 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.
SUP{PLEME�NTAL=tC®NSTR•:U,CT,I J�NrLI,E,N �A�.. ��,. ,::.� .�, ;��f„ �� . �°����'�:tr�+ ���?,�,'v+.:fir ��';��. � � �
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Applicable
_Not
Name: KeeseeAssociates Name:
Address: 945 Sough Change a�os5om Traci Address:
City: Apopka State: FL City: State:
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,
11
accessory structures, swimming pools, fences, walls, signs, screen roorris 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 LENDEWOR AN ATTORNEY BEFORE RECORDING'YOUR NOTICE- OF COMMENCEMENT.""'
34
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF Saint Lucie
The forgoing instrLpLMe t was acknowledged before me
this day of 20� by
The forgoing instr me t was acknowledged before me
this � day of 20� by
byun 11W
vi. man � a f
Name of p rson making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Produced _K.V1 D1N h
Type of Identification
Produced Y h OW r,�
(-kh
� uk iOMW
a UU1 ftUOAJ
(Signature Notary
of Public -State of Florida)
(Signature of Notary Public- Stateof Florida )
Commission No. V
No�ryPubtic s��
�te
s n No. —1 (Seal)
�yt�
. Hannah E Moore
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