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Home My WebLink AboutBUILDING PERMIT APP>>WW>/>/E&KDh^dKDW>d&KZWW>/d/KEdKWd Date: ____________________ Permit Number: _____________________ ƵŝůĚŝŶŐWĞƌŵŝƚƉƉůŝĐĂƚŝŽŶ WůĂŶŶŝŶŐĂŶĚĞǀĞůŽƉŵĞŶƚ^ĞƌǀŝĐĞƐ ƵŝůĚŝŶŐĂŶĚŽĚĞZĞŐƵůĂƚŝŽŶŝǀŝƐŝŽŶ ϮϯϬϬsŝƌŐŝŶŝĂǀĞŶƵĞ͕&ŽƌƚWŝĞƌĐĞ&>ϯϰϵϴϮ Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ________ Residential ________ PERMIT APPLICATION FOR: PROPOSED IDPROVEMENT LOCATION: Address: __________________________________________________________________________________________ Legal Description: ___________________________________________________________________________________ __________________________________________________________________________________________________ Property Tax ID #: _________________________________________________________________ Lot No.__________ Site Plan Name: __________________________________________________________________ Block No. _______ Project Name: ______________________________________________________________________________________ Setbacks Front__________ Back: _________ Right Side: _________ Left Side: ________ DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additional work to be performed under this permit – check all that apply: __ HVAC __ Gas Tank __ Gas Piping __ Shutters ___ Windows/Doors __ Electric __ Plumbing __ Sprinklers __ Generator ___ Roof Total Sq. Ft of Construction: ___________________ Sq. Ft. of First Floor: _________________________ Cost of Construction: $ _____________________ Utilities: __ Sewer __ Septic Building Height: __________ OWNER/LESSEE: CONTRACTOR: Name__________________________________________ Address:________________________________________ City: _________________________________ State: ___ Zip Code: ______________ Fax:____________________ Phone No._______________________________________ E-Mail:_________________________________________ &ŝůůŝŶĨĞĞƐŝŵƉůĞdŝƚůĞ,ŽůĚĞƌŽŶŶĞǆƚƉĂŐĞ;ŝĨĚŝĨĨĞƌĞŶƚ ĨƌŽŵƚŚĞKǁŶĞƌůŝƐƚĞĚĂďŽǀĞͿ Name: __________________________________________ Company: _______________________________________ Address: ________________________________________ City: ______________________________ State:____ Zip Code: ________________ Fax: __________________ Phone No. _______________________________________ E-Mail: __________________________________________ State or County License: ____________________________ /ĨǀĂůƵĞŽĨĐŽŶƐƚƌƵĐƚŝŽŶŝƐΨϮϱϬϬŽƌŵŽƌĞ͕ĂZKZEŽƚŝĐĞŽĨŽŵŵĞŶĐĞŵĞŶƚŝƐƌĞƋƵŝƌĞĚ͘ 5RRISLWFK 8532 Cobblestone DR CREEKSIDE PLAT NO. 1 (PB 55-12) LOT 101 (OR 4104-1937) 2326-600-0106-000-2 101 8532 Cobblestone DR ASHMEED MOHAMMED SOLAR 61680 ASHMEED MOHAMMED RUSSELL KILL 8532 Cobblestone DR PALMETTO SOLAR LLC FORT PIERCE 1505 KING ST EXT STE 114 34945 CHARLESTON SC (732) 433-9116 29405 anmoversllc@gmail.com 813-900-9772 PERMITTING_FL@PALMETTO.COM EC13009095 ✔ FL To Select from dropbox, click arrow at the end of line INSTALLATION OF ROOF-MOUNTED PHOTO-VOLTAIC SYSTEM. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: ___ Not Applicable Name:____________________________________ Address:__________________________________ City: __________________________ State: _____ Zip: ___________ Phone______________________ MORTGAGE COMPANY: ___ Not Applicable Name:______________________________________ Address: ____________________________________ City: _____________________________State: _____ Zip: __________ Phone:________________________ FEE SIMPLE TITLE HOLDER: ___ Not Applicable Name:_____________________________________ Address:___________________________________ City:_______________________________________ Zip: ___________ Phone:______________________ BONDING COMPANY: ___Not Applicable Name:__________________________________________ Address: ________________________________________ City:____________________________________________ 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording your Notice of Commencement. ___________________________________________ Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF_________________________________ The forgoing instrument was acknowledged before me this ____ day of _________________, 20___ by Eame of person making statement Personally Known _______ OR Produced Identification ______ Type of Identification Produced__________________________ (Signature of Notary Public- State of Florida ) Commission No. ______________ (Seal) ___________________________________________ Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF___________________________________ The forgoing instrument was acknowledged before me this ____ day of _________________, 20___ by ___________________________________________________ EĂŵĞŽĨƉĞƌƐŽŶŵĂŬŝŶŐƐƚĂƚĞŵĞŶƚ Personally Known _______ OR Produced Identification _______ Type of Identification Produced___________________________ ____________________________________________________ (Signature of Notary Public- State of Florida ) Commission No. ______________ (Seal) REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ _____________________ nature of Owner/Lessee/Cont _____________________ ture of Contractor/License Ho ic- State of Florida ) _______ (Seal) __ ( C @@@@@@@@@@@@@@@@@@@@@@@@@@ ____________________________ tate of Florida ) ____ (Seal) gnature of Notary Publ mmission No @@@@@@@@@@@@@@@@ l @ ___________________ Signature of Notary Pub ommission No. ST LUCIE ST LUCIE 23 RUSSELL KILL NOV 21 23 RUSSELL KILL NOV 21 X X