HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
PERMITTYPE: New Construction
Address:
Property Tax ID #: i 3 �/ ' -Dd �% —(�� �8' Lot No. �.J
Site Plan Name: _ Q'Im i11 ��( y)p Block No.
Project Name: 5�'tOM'eS ( NW r �Otf U0. �a(l
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Additional work to be performed under this permit — check all that apply:
X Mechanical Gas Tank _ Gas Piping Shutters � Windows/Doors
_
X Electric n Plumbing _ Sp.rinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: �(' �'J Sq. Ft.. of First Floor:
Cost of Construction: $ _ 314 '
,yoC) Utilities: � Sewer _ Septic7 Building Height:
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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: _ Address:3000 Gulf Breeze Parkway -
Zip Code: 32563 Fax: City: Gulf Breeze State: FL
Phone No.772-905-8394 Zip Code: 32563 Fax: 772-905-8511
E-Mail: pslpermits@adamshomes.com Phone N0772-905-8394
Fill in fee simple Title Holder on next page ( if different E-Mail Pslpermits@adamshomes.com
from the Owner listed above) State or County License CRC1330146
If value of construction is $2500 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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DESIGNER/ENGINEE,R. _Not Applicable MORTGAGE COMPANY: Applicable
_Not
Name; KeeseeAssociates Name:
Address: gas sou�n orartge e�osSomT,a�, Address:
City: Apopka State: FL City: State:
Zip: 32703 P h o n e 407-880.2333
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/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF salntLucie
COUNTY OF saintLucie
The forgoing instrument was acknowledged before me
this � day of. �Yif3,S'C�l 2014 by
The forgoing instrument was cknowledged before me
,
this � day of O_ _, 207A by
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w. �yo n a m 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 Know n
Type of Identification
Produced K in OW N�
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KLK, ftUOAJ
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. a�7o� � NQ�ryPuM�CSOsbp�
s nNo_ 'l I (Seal)
Hannah E Moore
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Expires07/01/202
REVIEWS
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COUNTER
REVIEW
REVIEW
REVIEW REVIEW expires 7roKMEW
DATE
RECEIVED
DATE
COMPLETED
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