HomeMy WebLinkAboutBuilding Permit Applicationr
15- L
13/1-''JDD - DOS G ^6910-3 Lot No. q d
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: L on `
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: 5 11
Property Tax ID #:
Site Plan Name
Project Name:
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
3
Total Sq. Ft of Construction: '-j,bQ Sq. Ft.. of First Floor: (�
Cost of Construction: $ '-3?:)gJt)b Utilities: ,� Sewer _Septic Building Height;
Name Adams Homes of Northwest Florida, Inc.
Address:3000 Gulf Breeze Parkway
City: Gulf Breeze State: _
Zip Code: 32563 Fax:
Phone No.772-905-8394
E-Mail: psipermits@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 VdluC u1 Lunsuuunon is ;pcsuu or more, a ittwKuto Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
ic° a r 2° �'' Y� r�!",�,'+�-..a?i `gyp •YN`Kk" sty •`a!✓�asS+3'�"r ffp. < t:s ?rfE+�: f-6 `txt ski r' r` e a x r-
�SUP,<P;LEM;ENT�AL�:CON�SETRU�
DESIGNER/ENGINEER:. _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Keesee Associates
Name:
Address: 945 so�tt, orange a�o55om T'rai� 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 nowork or installation has commenced prior to the issuance of a permit.
which is inoconflict with any applicablelHom that is
Association rwill
es,abylaws or the permit
that build
drestrict o�rproh bit 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."
FSgnature
3�11z
of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
ATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF SalntLuele
The forgoing instrument was acknowledged before me
this L day of (Ma(- ) 2021 by
The forgoing instrument was cknowledged before me
this day M
_
_l1_ of o,���, 207L1 by
N buciYi NO �
A hyyan ftda 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—Cl M M1
Type of Identification
Produced Y h OW NLoU
"t h � a k , WVJ
Al
O(SignatuUreof "Notary
(Signature of Notary Public- State of Florida)
Public- of Florida )
Commission No. VMC q� Notary PubkSdb
�State
ps n No. —1 I (Seal)
pZ
�
Hannah E Moore
- M m !
0
of,
Enpires07/01/202
REVIEWS
FRONT
COUNTER
ZO
REVIEW
REVIEW
VEGETATION na Moore
REVIEW REVIEW �zp!res 7rof(W
DATE
RECEIVED
DATE
COMPLETED
ev.