HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date:.. ..• tt Permit Number: r -
.5(/ V 09.
. RECEIVED
Building- Permit Application
APR - 5 2021
Planning and Development Services Permitting DePartment
Building and Code Regulation Division
St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: New Construction
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Address: r'7/0 16 Property Tax ID #: _3 LIP S�s� 6V �pl — (`��_l Lot No.6
Site Plan Name: S Block No.
Project Name: 1_ h< M-nmo_s
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Additional work to be performed under this permit - check all that apply:
%Mechanical —Gas Tank: _ Gas Piping _ Shutters Windows/Doors
X Electric Plumbing _ Sprinklers _ Generator A Roof ' Pitch.
Total Sq. Ft of Construction: ZZ Zi5-c5l Sq. Ft. of First Floor: l 1 l
Cost of Construction: $ 1 J `(� Utilities: ' Sewer x 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: _ 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 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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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name:ICeeseeAssocia�es - Name:
Address: 94s south orange 6�eseomTrali 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 niay 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.stru'ctures, swimming pools, fences, walls, signs, screen rooms and accessory use's`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 013TAIN 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
Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF salntLuole
The forgoing instru ent was acknowledged before me
this'0L day of , 20_ZA by
The forgoing instr ent was acknowledged before me
this _kj day of , 20V by
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
ProducedK.n ON n
_
Type of Identification
Produced Y_h OW IDS
h W 01 f% YJ
(Th
Y 1 WCAJ
(Signature of Notary Public- State of Florida)
(Signature of Notary Public--�
Stta�te of Florida )
Commission No.��� Jig NotaryPubhcSagis7,1—m-Wenn
1
No. -` (Seal)
Hannah E Moore
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REVIEWS
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Expires07/01/202
VEGETATION
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COM_ PLETED
ev. 2/7/19