HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-0
All APPLIC
ABLE IIVFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: O Permit Number: '
SCANNED
0 RECEIVEA
Elio8Buifi 1 g Permit Application AUG 14 2019
Planning and Development Services
Building and Code _Regulotion Division ST. Lucie County, Pern
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address:
Additional work to be performed under this permit— check all that apply:
t/_Mgchanical GGaasTank _Gas Piping _Shutters Windows/Doors
_ ElElectric ✓Plumbing _Sprinklers _ Generator Zof Pitch
Total Sq. Ft of Constructions: - 3 9,e Sq. Ft. of First Floor-/7&1)
Cost of Construction: $.23Z C&co Utilities: —Sewer a' Septic Building Height:
:
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Name AdamsH=%/01'+Nor*westFtoride.k=
Name: Adams licimes of Northwest ROMA, I iamBry A
Address:_ GLw 91Q�t leuj�,
Company: AdamsHomesd Nonhwestflodda InG
City: IJtF E State:l�—
Zip Code: z5a5i63 Fax:2%D•934. 80,3
Phone No. • G34. C+(j0
Address:—� C�CUF lam.
City: � State:
Zip Code: 3 3 Fax: • `I-3(-. SS33
Phone No S5 D . 9'&4.OLP70
E-Mail: �Slv2fm }[ ® 2td1—rn5 . nos WM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License�MILlb OF FL
n4..4C, Y ncwm,CU neoce or commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
-�632,S_
4S1PP'LEM_1FVAT
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DESIGNS NGINEER:
Not Applicable
At "Ic
Name: r
MORTGAGE COMPANY: _
Not Applicable
Name:
Addre s:
Address:
City:
State: L.
City:
State:
Zip: Phone -
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
of Applicable
Name:
Name:
Address:--
Address:
City:
City:
Zip: Phone:
Zip: Phone:
vvvovcn/ . Wlv I rVJ vn 14rr1uv11: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work dr 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 SfTE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENC T^
EMEN.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder I
STATE OF FLORIDAC�
COUNTY OF Jam+ rrn
STATE OF FLORID
COUNTY OF 1w
The forgoing instryyyggq���ent was acknowledged before me
this z0� by
The for oing instru ent was acknowledged before me
this�m q�, z0� by
William Br
William Bryan dams �10�
Br nkAd
William Bryan dams
Name of person making statement.
Name of person making statement.
Personally Known OR Produced
Identification _
Personally Known �L OR Produced Identification
Type of Identification
Type of Identification
Produced
ced
: 1✓:iFy ,, SHELLEYA.SEPULVED
.i�`•d;.., ,, SHELLEYA.SEPUL
.�; my COMMISSION#GG26
,; :,; MY COMMISSION
EXPIRES:�enuoryEXPIRES;
lanuary25,:
lure of NotaJ'a
' a ure of Notary Public- a• ,
Commission No. 667b20-14 (Seal)
Commission No. yG2.62074 (Seal)
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