HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONTSP112654
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Oar" LU_c ULe.
Building Permit Application
Planning and Development Services "
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 1204 N 37th St Fort Piero FL 34947 _
Property Tax ID #: 2405-701-0056-000-8
Ci+a Dian Nama•
Lot No. 9 and 10
Block No. 40
Project Name: - Noble PV Solar —
DETAILED DESCRIPTION OF WORK:
PV SOLAR I NSTALLATION -
New Electrical Meter Second Electrical Meter _ (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank —Gas Piping _ Shutters Windows/Doors Pond
Electric Plumbing _ Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 82000 Utilities: —Sewer _Septic Building Height:
OW N ERAESS EE: CONTRACTOR:
Name-QadJ F NOb a 8c$uhleJl�N_ohl.e I Name: Y ev- -
Address: 1204 N 37th St Company: Sow
City: Fort PiP-rcer State: R Address:G--
Zip Code: 34947 Fax: _ City: _ {�i �`MCYICL State: EL
Phone No. (772) 310-1086 Zip Code: ? 1k"JLk1 Fax:
E-Mail: m.l.mac67 mail.com _ Phone No
Fill in fee simple Title Holder on next page if different E-Mail 7 fir' (ari
from the Owner listed above) State or County License L1 -
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
TSP112654
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Name:.
Address:_
Address
City: _
State:
City:
_
Zip: _ Phone
__.. _
Zip: Phone:.
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Not Applicable
_State:
_Not Applicable
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 hoiderto build the subject structure
wlii& is ii7 GCti131iLt VJitii alit' applicable Hcirie Ow1sers Association rUieS, bylaws Or Wild 4ovenants that may rE�triCt or prGhibit 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 recordin(, your Notice of Commencement.
Signatur Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF
Sworn to (or affirmed) and subscribed before me of 0 Physical Presence or Online Notarization
this day of _.#0Q1 . 20 ZZby
Name of person making statement.
Personally Known X OR Produced Identification _
Type of Identification Produced—
{Sigiic'_10p oyNotary Public -State of kbrida ) C
Commission No. 'Wq_"bq (Seal)
REVIEWS FRONT I ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 3=1
l,' KFtY$TAL ROORMUEZ OTERO
Notary Public -State of Fleride
YCam"Irn ion I HH 89784
My cornmission Expires
ap,R••t FeUruary 08.2025
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