HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 0a •�� ,
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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
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Address: nE V j
Property Tax ID #: Lot No. �3
Site Plan Name: ` U Block No.
Project Name: r ►'I
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Additional work to be performed under this permit- check all that apply:
X Mechanical _/ Gas,Tank , _ Gas Piping _ Shutters' Windows/Doors
y` Electric Plumbing _ Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: �5 ( V� Sq. Ft. of First Floor: -7- l 7
Cost of Construction: $ _3Z I Rd U Utilities: Sewer _ Septic Building Height,
�O'�UUN°ERA/LE�SS*�.�q3'���.: � �� a�. � ,3,. �.�:���.����,���Y�;.�� =;�,• ��� �:
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 No 772-905-8394
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 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.
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DESIGNER/ENGINEER: _Not Applicable
MORTGAGE,COMPANY: _Not Applicable
Name : I(eesee Associaiee
Name
Address: s4sso�inorangeB�ossomTrafi
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 holderto 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 arid 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 of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Saint Lucie
The foing instrument was acknowledged before me
org
this I l day of = b('LLa L
, 20M by
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced K,n ON V1
ure of Notary Public- State of Florida )
Commission No.
Hannah E Moore
� M mmi
7n, w Elcpves O1i01Q02
IGZWAVLAWYM
RECEIVED
DATE
COMPLETED
1117
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Saint Lucie
The forgoing ins nt was acknowledged before me
j!?,DCLftk(1dIrd
this' day Wof// ,�1r/�11/// //2���0 C by
a• ! 1 .1 • V
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced 14h OW I"S
l Ya�h Y 1 W
(Signature of Notary Public -State of Florida )
n No. "l I (Seal)
FRONT Zo COUN ER REVIEW REVIEW REVIEW v EGETEVIEWON