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All APPLICABLE INFOVUST BE COMPLETER FOR APPLICATION TO BE ACCEPTED
Permit Number: .d p o 3 - c! -22
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Building Permit App. Lication o zilk
Planning and Developrr?.ent Services
Building and Code Regulotion Division
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1.553 Fax: (772) 462-15.78 Commercial Residential X.
PERMIT TYPE: NEW CONSTRUCTION =
Address:
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Property Tax IDtt: ///-70a- 00-3
Lot No.
Site Plan Name: ADAMS HOMES
Block No.
Project Name: ADAMS HOMES OF NORTHWEST FLORIDA, INC.
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3 GA
Additional work to be performed under this permit - check all that apply:
�v Mechanical — Gas Tank -.Gas Piping _Shutters
Y Electric PI b'
Windows/Doors
um ing — Sprinklers Generator y R f
Total Sq Ft of Construction: at z2/o
Cost of Construction: $ ?° `god Utilitie
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 ( it different
from the O�rier:listed above)
0o Pitch
Sq. Ft. of First Floor:
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 772-905-839.4
E-Mail PSLP�R.MITS@ADAMSHOMES.CO.M
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 ce more, a RECORDED Notice of Commencement is required.
4 to / `
DESIGNER/ENGINEER: _Not Applicable
N a m e: Keesee Associates
Address: 945 South orange Blossom Trail
City: Apopka State: FL
Zip: 32703 Phone4o7-8.80-2333
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
yy work or installation has commenced prior to the issuance of a permit.
ie
makes
on
which is noconfli t with aony applicable lHo ethat
Olwners Association nit will rules abylawsZor andpermit
covenants that maybuild
restrict borproh bit 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.permif, 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."
5lgnature of Owner/. Le
ssee/Con[race'or as Agent for Over` Signature Contra cfor/License Holder?�
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Saint Lucie
COUNTY OF saintwcie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ( day of F «C� 20 ZZby this . I day of _�'L�P�,�•,
-2 20 2Z by
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Name of person making statement. Name of person making statement.
:_Personally:,) -town x 0'13R'roduced Identification Personal) Knbvvn xT
Type of Ide�n/tification y OR Produced Identification
Produced_ I�.n m n Type of Identification
Produced k 17 DW IDS
(Signature of Notary Public- State of Florida*(Signature_
of Notary Public- State of Florida
Commission No. O� q
� Notary public SosR> °�� s n No. —1 (Seal)
Hannah E Moore
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REVIEWS FRONT ZO Expires O7rpVEGETATION � na Moore
COUNTER REVIEW REVIEW +`Ki)`+1� Rom
REVIEW REVIEW Wrpires 7r0 fEW
DATE
RECEIVED
DATE
COMPLETED
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