HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �- )2'Z� 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) 462-1578 Commercial Residential X .
'ERMITTYPE: New Construction
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Property Tax ID M. 1311 7 6c) niyo obo Lot No. �p
Site Plan Name: L-pOyy\12-S AA Block No. g
Project Name: �d0JyL5_ N'Ci►�eS � Mwas
Additional work to be performed under this permit - check all that apply:
X Mechanical Gas Tank: _ Gas Piping _ Shutters Windows/Doors h
X Electric Plumbing _ Sprinklers _ Generator A Roof . Pitch
Total Sq. Ft of Construction: �S -� Sq. Ft. of First Floor: V.
Cost of Construction: $ 2!76 Utilities: %Sewer .—Septic Building Height: 9
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@ada.mshomes.com Phone N0772-905-8394
Fill in fee simple Title Holder on next page Of different E-Mail Pslpermits@adamshomes.com
from the Owner listed above) State or County License CRC1330146
f value of construction is S2500 or more. a RECORDED Nntira of rnmmanromnnr is rnmidwa
If value of HVAC is $7,5U0 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:
Address: e4ssoutr,orangee,o5somr�ait 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 holder to build the subject structure
which is in conflict with any applicable,Home Owners Association rules, bylaws or and that
covenants 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, sign, 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'IMPROY.EMENTS 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."
�Cntra�ctorlLic�enseolder
Signature o,f'Owner/ Lessee/Contractor as Agent for Owner
Signature of
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF saintLucie
COUNTY OF Saint Lucie
The forgoing instr ent was acknowledged before me
this day of W Y -,Y� 20�i by
The forgoing instrument was acknowledged �before me
this day of,
2� by
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ayi ftdamf
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 UN n
Type of Identification
Produced Y-n u "'s
WOU
(Signature of Notary Public -State of. Florida)
(Signature of Notary Public- State of Florida )
Commission No.M-11D99- Notary PupheSoale
om s n No. —` ! (Seal)
• Hannah E Moore
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