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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1
Date: LA_ J IN 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
PERMIT TYPE: New Construction
Address: _ n
Property Tax ID #:
Site Plan Nam
Project Name
Additional work to be performed under this permit — check all that apply:
X Mechanical —Gas Tank _ Gas Piping _ Shutters'� Windows/Doors
X Electric Plumbing _Sp.rinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: �000 Sq. Ft. of First Floor: — A _LIF I
Cost of Construction: $ —1 2-6I Utilities: _ Sewer —Septic Building Height:
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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: _
Zip Code: 32563 Fax:
Phone No. 772-905-8394
Address:3000 Gulf Breeze Parkway
City: Gulf Breeze State: FL
Zip Code: 32563 Fax: 772-905-8511
Phone No772-905-8394
E-Mail:pslpermits@adamshorries.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail pslpermits@adamshomes.com
State or County License CRC1330146
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IV0 UC uI L.unsuucLion is ac3uu or more, a KtLUKutu ivonce oT 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:
Name: Keesee Associates
Name:
City:
Zip:
Not Applicable
Address: 945South Orange Blossom Tr•al� �Address:
City: Apopka State: FL
Zip: 32703 P h o n e 407-880-2333
State:
T Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING'
Name:
Address:
City:
Zip:
COMPANY: Not Applicable
Address:
City:
Zip: Phone:
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 ermit.
St. Lucie County makes no representation that is granting a permit will authori a 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 dorhereby 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 cQQncurrency 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 of Owner/ Lessee/Contractor as Agent for lbcaner
Signature
of Contractor/License Holder
STATE OF FLORIDA
STATE OF
FLORIDA
COUNTY OF Saint Lucie
COUNTY
OF Saint Lucie
The forgoing instrum t was ac nowledged before me
this � day of , 20 by
The forgoi
this diay
g instrume t as a R owledged before me
of 20 by
byafl Hams
I hryan
How
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 DW h
Type of Identification
Produced
I k h DW r"s
at
WOU
(Signature of Notary Public- State of Florida)
(Signatur
of Notary Public- of Florida )
Commission No.
u�cS7VO-iddlery
s
��State
N,—(Seal)
�Hannah E Moore
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COMPLETED