HomeMy WebLinkAboutSOLAR PERMIT APPLICATIONUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
All APPLICABLE INF753k,
Date: �' "' Permit Number:
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- 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
PERMIT APPLICATION FOR:
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011
001
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Address: .
Legal Description:
Property Tax ID #: 9
Lot No.
Site Plan Name: fN-1 `% �r��J,(- Block No. e
Project Name:
Setbacks Front Back: Righ Side: Left Side:
14 x
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mona wor to e per orme un er t is permit — c ec a t at app y:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors
_ Electric 1z lumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ a 18' Utilities: Building
_ —Sewer —Septic Height:
WON
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Name /✓J /
Name.
Address, !
Company:
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City: �! State:rA-
Address:
Zip Code:` Y- a—';-- Fax:
City:- ? i e State: Ft
Phone No. 77;t .� 97% — 716 �
Zip Code: �3t C1 Fax:
E-Mail:
Phone No —% —],1—. `tom `;�'--Cz_KY
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 f r Owner
Signature of Contractor/License older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument as acknowledged before me
this day of G rtJ, 20�� by
this day of_/e : v,eZ 20_4/by
Name of person making sta ent.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
A 10 AA , IA 41)111y)
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(Signature OUP ary PubiV State of Florida Ll
(Signature of Nota u lic- St t of Florida)
Corn S. KARLEYMARIEGIESYNARNEY
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KARLEYMARIEGIESY•VARNEY
CO 9.NotoryPublic (Seal)
�rNkhliE-stateofFlorida
commission # GG099801
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= • Commission M GG 099801
r comm. Expire May 1, 2021
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REVIEW
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19