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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 2LD (D, �� e�Gi
Building Permit Application
Planning and Development Services JU4 6 4 1011
Building and Code Regulation Division P®rMitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 6t. Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
FERMITTYPE: New Construction
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Address:
Property Tax ID #:
Site Plan Name:
PIroject Name:
WIN
�
. nno-1
Nor"' N-t ' Flo
Lot No:
Block.No.
Additional work to be performed under this permit = check all that apply
ie Mechanical Gas Tank _Gas Piping _Shutters Windows/Doors
X Electric n Plumbing _ Sprinklers _ Generator A Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 0
Cost of Construction: $ a -IQ u I q '1V o Utilities: IX. Sewer _ Septic Building Height:
Name Adams Homes of Northwest Florida, Inca
Address:3000 Gulf Breeze Parkway
City: Gulf Breeze State:
Zip Code: 32563 Fax:
Phone No. 772-905-8394
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 Fax: 772-905-8511
Phone No772-905-8394
E--Mail pslpermits@adamshomes.com
State or County License CRC1330146
11 V91"C v1 LU113LI uLuun ib ?tauu or more, a KtLUKutu 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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DESIGNER/ENGINEER: Not A licable
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MORTGAGE COMPANY: Not Applicable
`
Name : Keesee Associates
-
Name:
Address: 945 so�m orange B,ossom r,a„
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 off -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 that
covenants 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 no:6-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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF SainLLucie
COUNTY OF Safnl fade
The forgoing instr ent was acknowledged.before me
this J U— day of 20�i by
The forgoing instrum nt was acknowledged before me
this t day oMW�l _1 AN by
N bvar1 Nam c
W. h an ftda w�r
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_ kh ow h
Type of Identification
Produced k h OW IDS
AIS h � at wyj
AJignature
ULU Y 1 W
of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. ���
Notary Pubbe
s n No. —1 i (Seal)
AP Sts, 9
Hannah E Moore
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NotilryiWIG
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