HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Plonning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1S78
Permit Number: _22677
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Building Permit Applicatior,01 t ti adV�
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Commercial Residential X
PERMIT TYPE: NEW CONSTRUCTION
Address:
Property Tax ID b: OD q6 DDT Tf
Lot No. 3
Site Plan Name: ADAMS HOMES
Project Name: ADAMS HOMES OF NORTHWEST FLORIDA, INC. Block No. _
Additional work to be performed under this permit — check all that apply:
v Mechanical — Gas Tank _ Gas Piping
Electric Plumbing _ Sprinklers
Total Sq. Ft of Construction: 4 qb(o
Cost of Construction: $ / LfUtilitie
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)
Shutters X Windows/Doors
Generator X_ Roof Pitch
Sq. Ft. of First Floor: 9�
s: Sewer _ Septic Building Height:
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.
DESIGNER/ENGINEER: _ Not Applicable
N a rn e : Keesee Associates
Address: 945 South Orange Blossom Trail
City: Apopka State: FL
Zip: 32703 Phone407.880-2333
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
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no y work or installation has commenced prior to the issuance of a permit.
ie
makes no
wthichcis nocontfli t with any applicableion HomeaOlwners Associationnting a irulesabylaws or andthe pcovenantsthat malyrestrict 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 grantin f th'
g o is 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 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 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 Sa;ntLucie
The forgoing instrument was acknowledged before me
this -I- day of Zi] Z -by
�V�14raam��
Name of ptSrson making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced i1
(Signature of Notary Public- State of Florida )
Commission No.
i Notary Pubk St®ts
Hannah E Moore
REVIEWS I FRONT I ZO
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Sant Luce
The forgoing instrument was acknowledged before me
this _91 day of Fe-6a , Zp7-2-by
-- byV an
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced KnuW r,-�,
AWL --
(Signature of Notary Public State of Florida )
n No. -( I (Seal)
AM%&4WI VEGETATION
REVIEW REVIEW