HomeMy WebLinkAboutBuilding Permit Applicationr
4_
All APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� Q
Date: �( Permit Number: �104— 0q C�
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: U� L .y �S V-LfX'0�_
Property Tax ID #: 1 -7C Z
Site Plan Name: Gi.&I.$, 1�
Project Name: �p jS
�J� %
Additional work to be performed under this permit —check all that apply:
is Mechanical _ Gas'Tarik ' _ Gas Piping _ Shutters'
X Electric Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: 0(n(Ij Sq. Ft. of First Floor:
Cost of Construction: $ 2,6Z I C[ 00 Utilities: Sewer _ Septic
Lot No.15�lV
Block No.
Windows/Doors
Roof . Pitch
Building Height:
.OWNER LESySaEE� zF �r t<�, E via! �::.„
kt5,i..' `aAE'a .tf;@'.. ` •. lr*s :::G��uNt. 1x_;:.,h G wi�,� t 2a..,,Ys r& t .4-?".,,1:�u<'&5. d;,w_.�;, '�, e?%a ;= .
3Svlr .T1Y ! - YKd' tW S'�4�
, vh : ,�
GONT�RACT®dR� y rlr. � . ,
hSr. .-"v'• `n r' , X�3etl: :i`` ca„�w t• n�Lr< 7, 's M
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: _
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@adamshomes.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
VO UC U wnxI ULL1U11 IJ;143UU Ur more, a KrLUKUtU imotice Ot Lommencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
�'�'•�1 x•kyt :L t.t itsP�':'4:�r ...��.,,-��y��(�td'; : ��XC��f�Et3:;�$. 't�'1iq:,'.4i1:�'�$]({:-&�xw:L-'Y.F:.Srls,'72j1'di i'a�f.Fia. ?�Sts��.',.G1 ,o xF:�. f.�.'' y:,.i".^'-'u �n,r�(�j
,?.4,.+A� :!ai .P k ���,iC � . � �x i'� `f. l4 �" , 1 q! f •� fi•_ ,,.{ „ /;_ ti''Wt'x�'°'kar �'x+r7t�xr `�lr�R'$'S�w.r£' �'�M!%1-•.. ri�i
5:.,.Arr,'�•iC#113rafr'�•."��S�.K1'iarx, f.��5,i!'1�%uAi�4Fr�`i's;;ppra,3�* tA'9r, Ty7YJ �4,.gE/��.'n,.�,.y f�. �VA741 ga�r''i � �`, `rg i�� 1����$xxFiC'k�g" tF� f�'•"E� �) ^K �� 'it �yfi"�r"if'F�jtii•r.2�S„¢R
M. Td?:.1.__t �,i'_ x._ `1'>,.t-"silli'C�x5L.vYlltii:'?�`rx_�L�t:'s�.L r. X•I� Nfi%:r3k .SY �r'}>` �fl:�.aY.Y?{.b11��- 'PU.i.YtSS"u=�
DESIGNER/ENGINEER: _Not Applicable
Name.; KeeseeAssocfates
MORTGAGE COMPANY: _Not Applicable
Name:
Address: 945 so�m oa�9e B�oSsom Trali
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 rion'-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."
� 31�c
t �I •�:
Signature of Owner/ Lessee/Contractor as Agent for Owner
_
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF Saint Lucie
The forgoing instr nt wa acknowled ed before me
this _`__ day of , 20by
The forgoing instent was acknowledged before me
this_[ day ofru g20:4by
Y�P�rya n �a m S
_W. Iry a►� � a �► f •
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 DN V)
Type of Identification
Produced K Yl OW IDS
al
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. �� � Notary PuWtcSte
Hannah E Moore
Apr
onG imam s n No. —1 I (Seal)
• M m i
17
REVIEWS
FRONT
10&
ZO
Expires 07/01/202
VEGETATIONft.-NuRaorviln,
na
MOoreCOUNTER
REVIEW
REVIEW
REVIEW
REVIEW
x ves
\& p es
7r0 I�}EW
DATE
RECEIVED
DATE
COMPLETED
ev.