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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) ,�I
Date: ,p • •� % Permit Number: �/ p to ' �oWit
RECEiVErI!
Building Permit Application JUN 04 '2021
Planning and Development Services
Building and Code Regulation Division Pennitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St, Lucle County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: NEW CONSTRUCTION
Address:
Property Tax ID #: _I 3 11 v -10 O , O p y a - � p � _ � Lot No. y
Site Plan Name: ADAMS HOMES
Block No. _
Project Name: ADAMS HOMES OF NORTHWEST FLORIDA, INC.
Additional work to be performed under this permit - check all that apply:
'Mechanical —Gas Tan,k _Gas Piping Shutters
— X Windows/Doors
Electric Plumbing _ Sprinklers
�j — Generator .�(Q_ Roo/f� Pitch
Total Sq. Ft of Construction: p -I Sq. Ft. of First Floor:
Cost of Construction: $ _ -I Si 0� 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: 772-905-8511
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 - QUALIFIER
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 No 772-905-8394
E-Mail PSLPERMITS@ADAMSHOMES.COM
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.
DESIGNER/ENGINEER: _ Not Applicable
N am e : Keesee Associates
Address: 945 South Orange Blossom Trail
City: Apopka State: FL
Zip: 32703 Phone 407-880-2333
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
...,,,,im 1 nru,i vR /ArrIUVI 1: 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 rn'ay,restrict orprohibit 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 l'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 Yn170 1 rpjnrD nD AIU At-rnnwlry nrcnnr
-- ---- - ��
� v■ a.V I..If.C1.ILC1/1CIY1.
�ofOw�nerlLesseJCntractor
Signature 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 � day of _ (I V , 20M by
The forgoing instrument was acknowledged before me
this pi day of V u,{V 20 o? I by
N bran 14ra o rm
A. by a H Ham 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_ K.h ON In
_
Type of Identification
Produced 1C Yl OW I\S
fthK�Ok W6A
a U&k ftUOAJ
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. � � p� Notary PulnccSdlip
om s n No. -C I (Seal)
Hannah E Moore
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Expires 07101i202
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