HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO. MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: Permit Number: _ �` (0 �—(? 3a
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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
PERMIT TYPE: New Construction
Address: f�(3Z . L
Property Tax I D #: 1_ :) 1 1
Site Plan Name: �C/Q/
Project Name:
W
Commercial Residential X
�r •
I / I
Lot No. 7
Block No. I_
Additional work to be performed under this permit — check all that apply;
X Mechanical_/ Gas Tank _ Gas Piping _ Shutters Windows/Doors
X Electric n Plumbing _ Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 00 Sq. Ft. of First Floor:
Cost of Construction: $ 3c)%! C)o Utilities: XSewer _ Septic Building Height:
Name Adams Homes of Northwest Florida, Inc.'
Address: 3000 Gulf Breeze Parkway
City: Gulf Breeze State:
Zip Code: 32563 Fax:
Phone No.7-72-905-8394
E-Mail: pslpermits@adamshomes.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: William Bryan Adams
Company: Adams Homes of Northwest Florida, Inc.
Address:3000 Gulf Breeze -Parkway
City: Gulf Breeze State: FL
Zip Code: 32563 Fait: 772-905-8511
Phone N0772-905-8394
E-Mail Pslpermits@adamshomes.com
State or County License CRC1330146
iT value oT construction. is. �z500 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.
/-
DESIGNER/ENGINEER: _ Not Applica
Name: Keesee Associates
Address: 945 South orange Blossom Trail
City: Apopka
Zip: 32703-' Phone4U7.880-2333
State: FL
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:.
City:
II I Zip: Phone:
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Pho i e:
BONDING COMPANY_f
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 priorto the issuance of a permit.
I
St. Lucie County makes no representation that is granting a permit will authorize the permit hpIder 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 rstrictions which may apply.
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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 revieew: room additions,
accessory structyres, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING. TO -.OWNER; =Y.OUR FAILURE- TO ,RECORD A NOTICE OF COMMENCEMEII�T MAY RESULT.IN YOUR PAYING
TWICE FOR -:IMPROVEMENTS TO YOUR- -PROPERTY. A NOTICE OF COMM ENCF�MENT MUST BE RECORDED AND
POSTED ON THE JOB_ SITE,BEFORE THE FIRST --INSPECTION. IF YOU INTEND �O OBTAIN. FINANCING, CONSULT
WITH YOUR LENDER OR AMATTORNEY BEFORE RECORDING YOUR NOTICE OF OMMENCEMENT."
3zl t 4 z
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/Lic nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY. OF saint Lucie
COUNTY OF Saint Lucie
'
The forgoing instr ent was acknowledged -before me ::
this H day of a �( J(\ 20V by _
The forgoing instrument Ovals
this: 1 ` day of �.
acknowledged before me
20 by
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Name of q. rson making statement:
Name of person. making sta
ement.
Personally Known x OR Produced Identification
Type of Identification
Produced- Kn �w lr1
Personally Known x
Type of Identification
Produced K Yl OW I'i
R Produced Identification
AA A
NUOAJ
(Signature of Notary Public- State of Florida)
Commission No. —1 9
Notary
iy SOn�
. Hannahh E Moore
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(Signature of Notary Public -State
omm s n No. qI
IPr�
of Florida )
I (Seal)
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Expires 07/01/202
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