HomeMy WebLinkAboutAPPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
ff LL c U c IJ i.� L -- 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: SOLAR
PROPOSED IMPROVEMENT LOCATION:
Address: 5111 BIRCH DR. FORT PIERCE, FL 34982
Property Tax ID #: 3402-608-0377-000-2 Lot No. 29
Site Plan Name: SOLAR BOND Block No. 50
Project Name: WILLIAM & MARY BAILEY PV SOLAR
DETAILED DESCRIPTION OF WORK:
INSTALL ROOF MOUNTED SOLAR PV SYSTEM
New Electrical Meter X Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters
aJ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 41158
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
_ Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MARY GRACE LYN BAILEY
Name: DANIEL YATES
Address: 5111 BIRCH DR.
Company: EFFICIENT HOME SERVICES OF FLORIDA LLC
Address: 9416 INTERNATIONAL CT N.
City: FORT PIERCE State: _
Zip Code: 34982 Fax: NSA
Phone No. (772) 971-9208
City: ST PETERSBURG State: FL
Zip Code: 33716 Fax: N/A
Phone No 844-778-8810
E-Mail: BONESMCCOY4@MSN.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail PERMITTING@EHSFL.COM
State or County License STATE - EC13008759
It 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: REYES RUIZ-DONATE
Address: 9416 INTERNATIONAL CT N.
City: ST.PETERSBURG
Zip: 33716
Phone 844-778-8810
FEE. SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name:
State: FL
Not Applicable
Address:
City: State:
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 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 recording our Notice of Commencement.
Signature bf Owner/ Lessee/Contractor as Agent for Owner
Signatu o ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST LUCIE COUNTY
COUNTY OF PINELLAS
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or
Online Notarization
this 261h day of OCTOBER 2020 by
this 26th day of OCTOBER
2020 by
.D /��-
Name of person making statement.
Name of person making statement.
Personally Known X_ OR Produced Identification x
Personally Known x OR
Produced Identification
Type of Identification
Type of Identification
Produced DL
Produced
atu Notary Public- State
a o tary Public- State F o i a
Notary Public State
1 FloridaCommission
No. GG253520Steffan King
Commission G
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2Tlissi n No. GG253520
q{ot ary Publio State ofMy
+°aSileffan King
Expires 0812812022
My Commission GG 2
Ex fires 08I28/3022
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