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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: .2 (U oDoz_
RECEIVED
4 Building Permit Application OCT 01 2021
Planning and Development Services
Building and Code Regulation Division St. Lurie County
2300 Virginia Avenue, Fort Pierce FL.34982 Permltiing
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: NEW CQNSTRUCT[ON
Address: Ole_,, A_-74)
Property Tax ID N: .3 %OD —
Site Plan Name: ADAMS HOMES
Project Name:-ADAMS HOMES OF NORTHWEST FLORIDA, INC.
:Lot No.-6-3
Block No. /
Additional work to be performed under this permit - check all that apply:
'v Mechanical — Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric Plumbing _ Sprinklers _ Generator X_ Roof Pitch
Total Sq. Ft of Construction: Sq. kt., of First Floor:
Cost of Construction: $ Utilities: ewer _Septic BuildingHeight:
/
g �L—
Name ADAMS HOMES OF NORTHWEST FLORIDA INC.
Address: 3000 GULF BREEZE PARKWAY
City: GULF BREEZE
State:
Zip Code: 32563 Fax: 772-90578511
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 FL
State: -
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 $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPI,EM.�NTAI �C®NSTRU�TI•®NL�IirE-,N LAW`
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DESIGNER/ENGINEER:, Not Applicable.
" 1
Name: KeeseeAssociates
MORTGAGE COMPANY: _Not Applicable
Name:
Add re$s: 845 South Orange,8lossom Trail
Add ress:
City: Apopka State: FL
City: State:
Zip: 32703 Phon.e407-880.2333
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 p.errnit 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_acces.soryuses 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, CONS_ ULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO.RIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF saintLucle
The forgoing instru ent was acknowledged before me
this � day �j
The forgoing instrument was acknowledged before me
of 20 %( by
this 9-1 day of %� � 20 Z( by
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�1. �rV a � r� �► f
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 bw h
Type of Identification
Produced h Ow IDS
ftUO AJ
(Signature of Notary Public- State
of Florida)
(Signature of Notary Public- State of Florida )
Commission No. No�ryPabft s��
s n No. '( I (Seal)
Hannah E Moore
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Expires 07/01202
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