HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I0q, f`33aLA
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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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Property Tax ID #: t III ( -7(' ) C c84 -% 000 L> Lot No.�_
Site Plan Name: IAJCA..4Y 5 i 6 mes Block No. Project Name:
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Additional work to be performed under this permit- check all that apply:
X Mechanical Gas Tank _ Gas Piping _ Shutters L Windows/Doors
X Electric n Plumbing _ Sprinklers _ Generator A Roof . Pitch
Total Sq. Ft of Construction: & co03 Sq. Ft. of First Floor:
Cost of Construction: $ �� n ! 0b 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: pslpermits@adamshomes.com Phone No772-905-8394
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: Keesee Associates Name:
Ad d ress: 945 South Orange Blossom Trail 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 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 & Owner/ 6 Lessee/Contractor as Agent for Owner
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Signature
of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF SalnlLucie
COUNTY OF saint Lucie
The forgoing instrume t was acknowledged before me
this day of Qv Gk 203oA by
The forgoing instru.�^ent was acknowledged before me
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this day of Ire ` C� 20Z� by
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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 n W i1
Type of Identification
Produced — h 0 W IDS
al WVJ
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(Signature Notary
of Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. .V�lary
pmm s n No. (�
` (Seal)
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Hannahstisile
Hannah E Moore
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VEGETATION Rom Moore160m
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Expires 07/01/20
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Rev.2/7/19