HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf,
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p
Date: Permit Number:
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Building Permit Application st. `UDea n�ene.
Planning and DevOopmentServices
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
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Address:,3
Property Tax ID #: j l �� �fja 'dj��j DDU� 8 Lot No.6�
Site Plan Name: Jr�CLYY 5 �mqa� Block No.
Project Name: �P�Q,�(1(1Si�iptl(\�2S IvoCl}��' IrIU ��C
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Additional work to be performed under this permit — check all that apply:
K Mechanical_/ Gas Tank _ Gas Piping _ Shutters� Windows/Doors
y` Electric n Plumbing _ Sprinklers _ Generator A Roof Pitch
Total Sq. Ft of Construction: �j� [� Sq. Ft. of First Floor: _T�-'�j
Cost of Construction: $ H 05, q60 Utilities: KSewer _ Septic Building Height:
Name Adams Homes of Northwest Florida, Inc.' Name: William Bryan Adams h
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 No772-905-8394
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 CRC1330148
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/ENGINEER: , _ Not Applicable
Name: Keesee Associates
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a i t ia6 y a t Pi'.Y ? .PI� FORMATIOI� � ��� ��'3x�if
MORTGAGE COMPANY: _Not Applicable
Name:
Address: 945 South Orange Blossom Trail
Address:
City: Apopka State: FL
Zip: 32703 Phone407-880-2333
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 Arpendments.
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 IN IF YOU .INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Saint Lucie
The forgoing instrument was acknowledged before me
this 'la day of , 202( by
N burn n HOME
Name of P rson making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced )�_nbwi1
(Signature of Notary Public- State of Florida )
Commission No. isla
j4p�� Notary PubhcSO®b
Hannah E Moore
M mmt
Oo, w Expires 07/01202
REVIEWS FRONT Z01�i(
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF SaintLucie
The forgoing instrument was acknowledged before me
this day of 0l 20Z1 by
�1. Iry a n �(a �► s _
Name of person making statement.
Personally Known x OR Produced Identification _
Type of Identification
Produced Y1tJW
:�a KAU WOAJ-
(Signature of Notary Public- State of Florida )
n No. —1 1 (Seal)
RaA VEGETATION
REVIEW REVIEW REVIEW