HomeMy WebLinkAboutBuilding Permit Applicationf
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
230D Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number: D O�i`
1
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Building Permit Application
Commercial Residential X
PERMIT TYPE: NEW CONSTRUCTION
Address:
Property Tax ID a: / 3
Site Plan Name: ADAMS HOMES
-- o l aS- ddo
Lot No. /- /y
Project Name: ADAMS HOMES OF NORTHWEST FLORIDA, INC. Block No. _
Additional work to be performed under this permit — check all that apply
% Mechanical
_ Gas Tank _ Gas Piping
— Shutters
Windows/Doors
Electric
Plumbing _ Sprinklers
— Generator
-K
�(_ Roof Pitch
Total Sq. Ft of Construction: _�, [o(�� Sq.
Ft. of First Floor:
(ia�
Cost of Construction: $
j (—Lnl �� Utilities:
,A" 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
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 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 to 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 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SafntLuclo-
The fooing instrument was acknowledged before me
this Irgday of _64Mbe�� Zp Z 1 by
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced_K n w
t(Sign,t,`reAfNotary Public- State of Florida )
Commission No.9 e�v�„y�,,
Notary PUN= Scale
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 forgoing instrument was acknowledged before me
this 'ILI day of zp1I by
�Nun n f-cl a w r
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification —
Produced K I)IJW ins
(Signature of Notary Public- State of Florida )
n No.Dj] q I (Seal)
0%6&4KJVEGETATION � IA R on n�oore �O
REVIEW REVIEW �xvires 7/oKN?fEW