HomeMy WebLinkAboutDeribin Permit Applic 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPR9;"V111INT, tOCAT10N:
Address: 209 Ramie Ln Port St Lucie, FL 34952
Property Tax ID #: 3419-515-0105-000-2
Site Plan Name:
Project Name: Michael P Deribin
DETAILED DESCRIPTIQN OF WORK
Roof top solar photovoltaic electrical system
New Electrical Meter Second Electrical Meter
CONSTRUL7(ON INF'ORMATION'
Residential x
Lot No. 15
Block No. 23
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: $-32,567.00 Utilities: _ Sewer _ Septic
Building Height:
OWNERAESSEE;
CONTRACTOR:
Name Michael P Deribin
Name: Matthew Herriford
Address:209 Ramie Ln
Company: Big Orange Solar LLC.
Address:8026 SW 21 Court
City: 209 Ramie Ln State: _
Zip Code: 34952 Fax:
City: Davie State: FL
Phone No. 954-789-9092
Zip Code: 33324 Fax:
E -Mail: Permits@bigorangesolar.com
Phone No954-789-9092
E -Mail Permits@bigorangesolar.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County LicenseCVC57040
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.
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SUPPLEMENXA'�CO S 11,�T� %L'EN,LA ,iNFORMAT�t�N:
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 inaicacea.
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 paying twice for
improvements to your property: A Notice of Commencement ust be recorded in the public records of St.
Lucie County and posted on the �obsite before the first inspe i n. If you intend to obtain financing, consult
with lender or an attorney before commencingwork or rec n our Commencement.
Signature of Owner/ Lessee Contractor as Agent for Owner nature of Contrac se Holder
STATE OF FLOD STATE OF FLORI
COUNTY OF (IJ Cl COUNTY Ol '
Sworn to (or affirmed) and subscribed before me of
P sical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _?Sday of D:,�% 2020 by
Name of person making statement.
Personally Known OR Produced Identification Personally Known "h—_ OR Produced Identification
Type of IdentifLati4n Type of Identification
,
Pro ed i2 8'I� Prod ed
tate of Florida
(Si a re of No7X!_9
State of Florida (Si f Notary u - t &t ro w1 rmo resone
llbrmo GG �eso�j ExpireMY i��$ilm �211183
22Commission No. aCommission No. �0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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