HomeMy WebLinkAboutGromley Permit ApplicationAll 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 Residential X
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 385 NE Bracken RD Port St Lucie, FL 34983
Property Tax ID #: 3419-570-0128-000-0
Site Plan Name:
Project Name: GORMLEY RESIDENCE
Lot No. 8
Block No. 82
DETAILED DESCRIPTION OF WORK: I
INSTALLATION OF SOLAR PV SYSTEM TO ROOFTOP
New Electrical Meter Second Electrical Meter
(Affidavit required)
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
X Electric _ Plumbing _ Sprinklers _ Generator
URBAN SOLAR GROUP/ KIMANDY LAWRENCE EC13005324
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ��, Y/0 Utilities: _ Sewer
Windows/Doors _ Pond
Roof Pitch
_Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Edward Gormley;Cynthia N Gormley
Name: MICHAEL VERGONA
Address: 385 NE Bracken RD
Company: URBAN SOLAR GROUP
City: Port St Lucie State: FL
Zip Code: 34983 Fax:
Phone No. 5616092664
E-Mail: PERMITTING@URBANSOLAR.COM
Address: 990 S ROGERS CIR STE 4
City: BOCA RATON State: FL
Zip Code: 33487 Fax:
Phone No 5616092664
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-
Mail PERMITTING@URBANSOLAR.COM
State or County CVC56948
License CVC56948
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.
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 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 your Notice of Commencement.
Signature of O� Lessee/Contractor as Agent for Owner
Signature Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF raI m 13cctch
COUNTY OF Pcllm Be-acl)
Sworn to (or affirmed) and subscribed before me of
_2!� Physical Presence or _ Online Notarization
this10dayof 1% e_ 20ZI by
Sworn to (or affirmed) and subscribed before me of
iC Physical Presence or _ Online Notarization
this r0dayof S, tnC' 202�L by
MICHAEL VERGONA
MICHAEL VERGONA
Name of person making statement.
Name of person making statement.
Personally Known i- OR Produced Identification
Personally Known '<' OR Produced Identification
Type of Identification Produced
Type of Identification Produced
(Signatureo6f Notary Pu ;St{g,gf Flo6
�,s Notary ublic•State of Florid
Commission No. �• Copm$1$sion 8 HH 67659
M 4 mission Expires
10.110 q November 30, 2024
(Signature otary Public -Stet
ommission No.fiea
L� ) SLE
-� =•Notary Public•State of Fiji
- = commission K HH 67
y Commission Expi
111o` November 30, 202
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