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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 99 Permit Number:r, 41
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OMA I .4
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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
PERMIT TYPE: 1\1 n i . 1 / (A \)
Address: NO is // Dht.l,`SQ(f�
Property Tax ID #: Lwod - I'.e(&
Site Plan Name:Adom g
46
I.,
Project Name:A&MS �/tliM�t
Building Permit Application
4
Commercial Residential
600 -9 Lot No. —
Block No.L
e A wiA Hen _ 3;r .
Additlal work to be performed under this permit- check all that apply:
_Mechanical _ GasTank _ Gas Piping _ Shutters Windows/Doors
-'-*Electric Plumbing _ Sprinklers _ Generator Roof Pitch
22 i
q �J �� Sq. �Sewer
First Floor: ��
Total S `.' Ft of Construction:"�
Cost of Construction: $ ��l,.0 Utilities: _ Septic Building. Height:
k �i j
Y52ti t a a � .Cs�•.+i �'^ �� rS.
�:tis1�.0 _�J4 K&.aree,r1 }'31sC i^ ITie .]4 nW 1 f il^(
CONTRAR
1. CTOt�•
Name Adams HWM 0fNoMwest Florida. h=
Name: Adams Homes of NoMwwt Florida,!2J WilfiamBrYgAdd
Address: -�- pt<,It kU4.
Company: AdamsHomesofNorthwestFtorida,1=
�"�'u�
city: �Uc-F ict State: P-
�.
Address:3 �u-cF•
Zip Code: 3 3 Fax: •'93: 553?
City: AVEW State: PL-
Phone No. 85b • q'•y4- C7 PIO
Zip Code: 3 Fax: • 1-54• 5533
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E-Mail:_ p6192cm; -ck i,7%3hcmeT.wm
Phone No S5a CLr10
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License CyzMDIL16 4,:jn�C;F �
IT value of construction is 5Z5UU 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.
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S�UFP ME`NTA C®NtSTRIJC
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N I N [A INFOR
E.� ,.fir ... n'S, J' "`'.y`:i..v, . +� °�"1 - v -. s..� neh. e7'.7
ATION A� '� ; 1�IV0011
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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 dr 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
"WARNINC 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."
i I�IZL'S�L�� �_ (r
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA('STATE OF FLORID
COUNTY OF im4 COUNTY OF
Tr4
The for oing instr ent was acknowledged before me The for oing instr ent was acknowledged before me
this �� day of 20� by this /� day of 1P.1 I A% 20 9 by
William Bryan dams aws(o�r William Bryan am5 �( ,
Name of person making statement. i Name of person making statement.
Personally Known OR Produced Identification Personally Known ,/ OR Produced Identification
Type of Identification I Type of Identification
Produced ced
��►�' •. SHELLEYX SEPULVED .►� .. .; SHELLEYA. SEPULV
My COMMISSION # GG 26 `;: MY COMMISSION # GG
Pam: EXPIRES- 4anuary 25 EXPIRSS:,lanuary 25,
••: gyp•. p9`i
a ure of Notary Public- a
ture of Notary Pu a
Commission No. C i2(62orI4 (Seal) Commission No.Cfi b2y* (Seal)
REVIEWS FRONT CE7E
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
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