HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r^
Date: Permit Number: l l�^ D(f((/5
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 I
Address: 5'1 J_S LGt- l)
Property Tax ID #: 1311,0 Lot No.
Site Plan Name: �AQm'g Rbm ,, ((�' 1 l Block No.
Project Name: ►'1CfC�JMS� �M'eS ofi- N W \b�C� Aa__ -Ev--v
Additional work to be performed under this permit— check all that apply:
X Mechanical Gas Tank _ Gas Piping _ Shutters ��//� Windows/Doors
X Electric /� Plumbing _ Sprinklers _ Generator A Roof . Pitch
Total Sq. Ft of Construction: `S a _ Sq. Ft. of First Floor: *7 ib
Cost of Construction: $ 3 L 4f q�y Utilities: Sewer _ Septic 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: —
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
•^� �• •'����� �����+�� a qc aVV VI IIIVIC, d nct-unucu imoxice oT Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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�,,.,�.,,., , •,,�. w �„ „x CTION�LIENLAW' INFOR�MATI�®.N� t ������ ���.�,� .����a;� r.
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DESIGNER/ENGINEER: Applicable
_Not MORTGAGE COMPANY: _Not Applicable
Name: I(eesee Associates
Name:
Address: s4sso�more�ge6ioseomrraii 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/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 instrument was acknowledged before me
this _ L day of _iYiQX—C --) , 2021 by
The forgoing instrument was cknowledged before me
this _LV_ day of M a_C_, 201ZJ by
N Yvan 14dom c
A hyyan faa mf
Name of p rson making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Personally Known x OR Produced Identification
Produced_ K n ()w h
Type of Identification
Produced Y_"r3w IDS
Whal, AMAJ
(Signature of Notary Public- State
of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
NoWryPubheSO®b
o q� s n No. —1 I (Seal)
��Sr
Hannah E Moore
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Expires07/01/202
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DATE
RECEIVED
DATE
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