HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��� r ,� Permit Number: .62%
RECEIVED
Building Permit Application APR e 5 2021
Planning and Development Services Permitting Departmen,
Building and Code Regulation Division St. Lucie Count,
2300 Virginia Avenue, Fort Pierce R 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: New Construction
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Address: „ 77�
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Property Tax ID #: -_ 3�'�j --�� 0610 666 - (4 Lot No. C7
Site Plan Name: ki�W Block No. CD
Project Name: �,�-r L? AAA Dow, rja.l�K C $2G l
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CONSTRU�GT�ION I.NFORMA�T1.0'N�.�5.,�w 'p�`� a�t;�•j�� �ats•y F �n�..�`.� =g,,fz�c;���„� k ,,.���G,����r�,R,r� ,,, �. � ..t'7`Ir� w.,:•�,•4 � .,��t ,,�;,_
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Additional work to be performed under this permit — check all that apply:
X Mechanical ,—/ Gas Tank' _ Gas Piping — Shutters Windows/Doors
X Electric n Plumbing
K' _ Sprinklers — Generator Roof' Pitch
Total Sq. Ft of Construction: J� Sq. Ft. of First Floor:
Cost of Construction: $ .�� Utilities: Sewer k Aeptic Building Height:
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safrzuza +.a CONTRA'CT®,"..��
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-Marl psipermits@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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SUP;PLEM�E�NTAL CONSTRUC�TI,��<N LIE� �L�A�W�tN�F�OR�MA�Tl�O'N� ��� �� ����� ���`��,�����k,•
DESIGNER/ENGINEER: -- _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: xeesee Associates Name:
Address: 945 Sa�th orange eio55om bait Address:
City: Apopka State: FL City: State:
Zip: 32703 Ph 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 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 t.o 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 Twill, 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,
accessorye
structures, swimming pools, fences, walls, signs,,scren'rooms and adcessory'uses'to'anothe'r 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF SaintLucie
The forgoing instrum nt was acknowledged before me
this�dayof�,r.� 2T4 by
The for oing instru nt was acknowledged before me
this �<� day of A'r - 20' by
. �ruan H.aWf
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 n O W n
_
Type of Identification
Produced Y_Yl OW r,S
IN W A WyJ
UUJ MOAJ
Ga
�
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- of Florida )
Commission No.
NotaryPubhcStwte"ormnmn
]State
No. -1 1 (Seal)
��Sqa
Hannah E Moore
• M mmr
REVIEWS
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Expires 07/01/202
VEGETATION
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Moore
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
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7/0p'1tqfEW
DATE
RECEIVED
DATE
COMPLETED
ev. 211119