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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I�
Date: Permit Number:
Building Permit Application
Planning and Development Services
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
Address:
Property Tax ID r : 131/
Lot No. 3 q
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:
Ci Mechanical _ Gas Tank _ Gas Piping Shutters
— X Windows/Doors
Electric Plumbing _ Sprinklers Generator
— ,K_ Roof Pitch
Total Sq. Ft of Construction: 3.1 130 Sq. Ft. of First Floor:
Cost of Construction: $ 3 % , �6)0 Utilities: v Sewer _ Septic Building Height:
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)
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
F value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: ^_jNot App�licables
N am e : Keesee Associates
Address: 945 South Orange Blossom Trail
City: Apopka
State: FL
Zip: 32703 Phone 407-880.2333
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.
es
wihichcis noconflic with any applicablelon Ho ethat
Otwners Associationnting a lru rules, or andthe pcovenantsthat malyrestrict ojrprstructure
h bit suc
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may a I h
perform the
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, y pp y
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.work
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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Salnl Lucie
The forgoing instrument was acknowledged before me
this day of 20 2( by
Wc
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced_ Ln �w h
(Signature of Notary PubIri,-State of Florida )
Commission No. -D I I V �
Notary Pups Stet®
Hannah E Moore
REVIEWS I FRONT I Z01�
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
I trpres071012o2d
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Saint Lucie
The forgoing instrument was acknowledged before me
this 1S day of I c 20� by
Mai ftrjawf
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced y_h b W M
:HaIAU, tom
(Signature of Notary Public- State of Florida )
No. I
VEGETATION
7EVIEW"4rR=VIV1 REVIEW
(Seal) .
xpires P710R"IN?fEW