HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: AA VD - 3�A Permit Number:
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) 462-151.8 Comrriercial Residential X .
PERMIT TYPE: NeW Construction_
Address: 0 'nj d (a !D0LPP�\\ '�t✓dy�` ^`O V d
Property Tax ID #: ] v ® �
s- � Lot No. I�a
Site Plan Name: Block No.
Project Name: o Ill
Additional work to be performed under this permit = check all that apply;-: -
XMechanical'
echanicalGas Tank _ Gas Piping _Shutters Windows/Doors
y` Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: �3 Z�. Sq. Ft. of First Floor: 7
Cost of Construction: $ Z -71 16 0 Utilities: - Sewer _ Septic Building Height:'
Name Adams Homes of Northwest Florida, Inca 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: psipermits@adamshomes.co.m Phone 1\10772-905-8394_
Fill in fee simple Title Holder on next page ( if different E-Mail pslpermits@adam' homes.com
from the Owner listed above) State or County License CRC1330146
It value or consiruction is :�e5uu 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.
CCiNST.RUCT � ,��. t
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DESIGNER/ENGINEER:. _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: KeeseeAssocfates Name:
Address: sassou�norange9�pssomTral� 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:
Zip: Phone:
Zip:: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and in 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 deed for
review your 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 rpoms and accessory uses to another rion-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 B. E 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."
�tSignature 3��df
Owner/ Lessee%Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF saint.Lucid
COUNTY OF Saint dude
The for ,going instr ent was acknowledged.before me
this day of ti I 202i by
The forgoing instrument was acknowledged before me
this day oft�YY�_ 2p._�
by
{�L� �v a n ►4r� r �s
Val . Iry a n a w f
Name of p. rson making statement.
Name of person making statement.
Personally Known x OR Produced Identification T
Personally Known x OR Produced Identification
Type of Identification
Produced- K ri D W Y)
_
Type of Identification
Produced 1C Y10 W IDS
(Signature of Notary Pu{b�lic=State'of Florida)
(Signature of Notary Public- State of Florida )
Commission No. Notary PuSt,�
° s n No. -( f (Seal)
:P Hannah E Moore
- M MMI
0
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Expires 07/01202
REVIEWS
FRONT
ZO
VEGETATION; Henna Moore.
�xpirWi
COUNTER
REVIEW
- REVIEW
REVIEW REVIEW >/�)7r0 W
DATE
RECEIVED
DATE'
COMPLETED
Rev. 2/7/19