HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: 10 3 — o {q L.
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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
PERMITTYPE: New Construction
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Address: SEII I L LkAb
Property Tax ID #: Z t I -'-7(.>o - l) c> 1 " 6CO " C Lot No.—H 9_
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Site Plan Name: CLMS t�t�rY1�.S
Block No.
Project Name: oC Z`t\W�"�'
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Additional work to be performed under this permit — check all that apply:
is Mechanical_/ Gas Tank _ Gas Piping _ Shutters Windows/Doors
y` Electric n Plumbing _ Sprinklers _ Generator A Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: I n Zy
Cost of Construction: $ T4 0C.) Utilities: Sewer _ Septic Building Height,
�p�/�N�E R��E�aE;�� ��� ��: � �; ��,������ : ���� �CO�NT�R�A�e�T®A�;� •_' a '°�'� ty � "` , ;% �
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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 N0772-905-8394
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 Applicaable
MORTGAGE COMPANY: Not Applicable
Name: KeeseeAssociates
_
Name:
Address: 945 south orange B�cseomha�,
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 th,e 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SaintLucie
The forgoing instrument was acknowledged before me
thist dayof_MCIrC1V) 2011 by
NbU61 Yl Hd0 M S
Name of p rson making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced KY) M h
(Signature of Notary Public- State of Florida )
Commission No. a"���
i NoWry PuW_ Soe1®
'Hannah E Moore
REVIEWS FRONT ZO
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF SalntLude
The forgoing instrument was acknowledged efore me
this _L!� day of M � Y - ; 20 &1 by
A Iryan ftdoms
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced IC. Y) OW 11`1
l a kL WOU
(Signature of Notary Public- State of Florida )
No. +( I (Seal)
Aab&4" VEGETATION
REVIEW REVIEW