HomeMy WebLinkAboutBuilding Permit Application 1 �
All APPLICABLE IWO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L+ Q—IN Permit Number: I
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Building Permit Application
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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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PROPOSED IMPROVEMENT r , urta _,y.,. _ r., . _ r -
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Address: 'ovQ -' V L Lko c) �
Property Tax ID#: 0C) 0c)q 6 (n 0 Lot No. I I
Site Plan Name: - S m Block_ No. 0
Project Name:
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Additional work to be performed under this permit-check all that apply:
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X Mechanical _( Gas Tank _Gas Piping _Shutters �/�Windows/Doors
X Electric (` GPlumbing _Sprinklers _Generator . �/, Roof . Pitch
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Total Sq. Ft of Construction: � -S � � Sq. Ft. of First Floor: V `
Cost of Construction: $ 2�� �U� Utilities: XSewer _Septic Building Height,„ B
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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 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 �I
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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. j
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SSUPPLEMENaTAL'CONSSTRUCI"ION�LI�EN�L�AW INFORMA�T'�IO'N�� ������� �� f�; ,��'Ya r r�� ���{���� �.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: KeeseeAssociates Name:
Add res5: 945 South Orange Blossom Trail Ad d re5s:
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 j
"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 Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SaintLucie COUNTY OF SaintLucie
The fonrI�� oing inst=VdA
was acknowledged.before me The forgoing instrument was acknowledged before me
this IL day of 20`�! by this I 1 day of �,20A by
yun Haws
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 Type of Identification
Produced 011 Uw 1n Produced Yl OW 1�
WyJWOAJ
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-Sttafte of Florida)
Commission No. 1� V �,,IrS NotaryPubheSoab 1prmI
n No. l 1 (Seal)
Hannah E Moore
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awn Expires 07/01202 q
Wna Moore
REVIEWS FRONT ZO VEGETATION R .", =QIteva
COUNTER REVIEW REVIEW REVIEW REVIEW expires 7/OKtWfEW
DATE
RECEIVED
DATE
COMPLETED
ev. 217119