HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �'� 11�7 1�1—(
Date: �. I Q0 Permit Number: ae) a__e �i I J
Building Permit Application LST.
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
Address: 06 ZU AM.A
Property Tax ID #: 13!
Site Plan Name: 0
Project Name:
RIP
I❑
1, /
Additional work to be performed under this permit — check all that apply:
X Mechanical _/ Gas Tank — Gas Piping — Shutters.'
y` Electric n u Sprinklers Generator
Total`Sq"`Ftaof Construction Sq. Ft. of First Floor: _
Lot No. % a
Block No.
��//
X Windows/Doors
A Roof . Pitch
Cost of Construction: $ �I Utilities: —Sewer —Septic Building Height:
�.CONTRACTOIR�,.
sSl.T.'E�',a_.�'WE:n,:i;�v.'..
�,,7u..rs�txtic�;'tuit�fa*�"'y .,l.*+.r kh"'^r .'p,: r
3 ;,`, Jack'' z•,r;
�� �f �Y
,v#
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: pslpermits@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
n vawc ui LUMLIULilon is;oz3uu or more, a KtwKutu Notice oT commencement is required.
If value of HVAC is $7,S00 or more, a RECORDED Notice of Commencement is required.
S:UPhP,LEM.ENTA:LC�ON�S{pT.R3.U'CTI®N LIEiN;gF111/ IN•FpR,,
: /��gaF�I'� N���, ,,L��;`�'`,.. �� �'�..'�,��� .;��`��;W. � �,��;��
DESIGNER/ENGINEER:.,; --� _Not Applicable
Name: KeeseeAssociates
MORTGAGE COMPANY: _Not Applicable
Name:
Address: saesouino�a�9eeios5omr�au
Address:
City: Apopka State: FL
Zip: 32103 Phone407-880-2333
1
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
11
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 fdr any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,J,ri 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,,,screern,rocros'and.accessbry uses to. another non-residenfial 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 R .YOI ..NOTICE OF COMMENCEMENT. "
_ QI L(
ature of Owner/ Lessee/Contracto al Age t for Owner
STATE OF FLORIDA
COUNTY OF Saint Lucie
The for,going instrun;ent was acknowledged before me
this day of 204 by
Name of p rson making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced ) .hON h
(Signature of Notary Public- State of Florida )
Commission No. -11D9 ��`°'�
7Expires
tary Public Soule
nnah E Moore
m07toI:
REVIEWS FRONT I ZOF""
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Saint Lucie
The forgging instru en was acknowledged before me
this � day of Its Pdke 20 by
ry an ftda f
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced Y h O W "'s
(Signature of Notary Public- State of Florida )
n No. `1I (Seal)
sRdo� VEGETATION
REVIEW REVIEW REVIEW