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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��((
Date: Permit Number: 2/602 ' U C2
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Building Permit Application St. Lu eC Count
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
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Address: 7 Gon (en QI
PropertyTax ID #: :3 " 7o] oUZ7 UQb- 5 Lot No. Zb
Site Plan Name: �, Block No. S�
Project Name:
Mamn my--,_ .qor U1 eq-k..
Additional work to be performed under this permit— check all that apply:
X Mechanical _J Gas Tank _ Gas Piping Shiitrarc
y` Electric Plumbing _Sprinklers
Generator
X Wiridows/Doors
A Roof . Pitch
Total Sq. Ft of Construction: ' ?Ltbq Sq. Ft. of First Floor: I ?Z(f-�
Cost of Construction: $ Z1�p1p �(� (� Utilities: X Sewer _ Septic Building Height,
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Name Adams Homes of Northwest Florida, Inc.'
Name: William. Bryah 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 N0772-905-8394
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
va�uc uwnsu uLtwn ib acauu or more, a KtcUKUtU imotice 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: _Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name : I(eesee Associates
Name:
Address: s4sso�thora�geeiossomrra{�
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 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/contr-adtor as Agenf for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF SalntLude
The forgoing instr ment was acknowledged before me
thi! 2rday of 20:Zj by
The forgoing instrument was acknowledged before me
thisZ day of JoLa 20_7A by
Fmon
byNayi ►.0 ► 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,Yi M h
Type of Identification
Produced Y n uw f�,&
at wui
I 6UOAJ
hof
(Signature of Notary Public- State of Florida)
(Signature Notary Public- of Florida )
Commission No. ��� �.� NotaryPubhcSo.b
. Hannah E Moore
�State
Qm s n No. —` I (Seal)
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