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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: "1
—v—
RECEIVED
MAR 2 5 ilding Permit Application
Planning and Development Services permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578 1 Commercial Residential X
PERMIT TYPE: NEW CONSTRUCTION
Address:
f1
Property Tax ID tt: 1-3 l/- f76d - 00$9 -l' ooeo_ L _
Lot No..
Site Plan Name: ADAMS HOMES I
Project Name: ADAMS HOMES OF NORTHWEST F,LORIDA, INC. Block No. _
Additional work to be performed under this permiti check all that apply:
�i Mechanical — Gas Tank _ Gasi Piping _ Shutters
K Windows/Doors
Electric Plumbing _ Sprinklers _ Generator �(_ Roof
Pitch
Total Sq. Ft of Construction: 3,Sja Sq. Ft. of First Floor: 0?
Cost of Construction: $ '46044e)0
Utilities: Sewer —Septic Building Height:
Name ADAMS HOMES OF NORTHWEST FLORIDA INC.I
Address: 3000 GULF BREEZE PARKWAY
City: GULF BREEZE State:_
Zip Code: 32563 Fax: 772-905-8511 1
Phone No. 772-905-8394
E-Mail: PSLPERMITS@ADAMS HOMES.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner Fisted 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: 712-905-8511
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.
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.
akes no
on
wthichcis inconflictwith any applicable IHomethat
Oiwners Associnting a ation rules ill authorize
or andpermit
covenants that maybuild
restri t ojrprstructure
oh bit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the rantin ift-
g 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 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."
gnature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Saint Ludo -
The for oing instrument was acknowledged before me
this day of j , 20 ZL by
ly n ►4ra a m
Nance of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced _U O w iI
(Signature of Notary Public- State of Florida )
Commission No. ��� 9✓v�V�,r
Notary Public State
Hannah E Moore
REVIEWS I FRONT I ZO
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/license Holder
STATE OF FLORIDA
COUNTY OF Saint Lucie
The for oing instrument was acknowledged before me
this y day of �- 20 2-2-by
buaftdry wf
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced V—hbW IDS
Lid p 1 W O
AJ-
(Signature of Notary Public- State of Florida )
n No. q I (Seal)
NA&4WJ VEGETATION dR on
REVIEW REVIEW �/1) xpves