HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0/4 �aZD�I
Permit Number:
DI
9 ' �" Building Permit Application
Planning and Developmen t Services
Building and Code Regulation Division Commercial Residential)
2300 Virginia Avenue, Fort Pierre FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: -
Address: 5909 Green Dolphin ST Fort Pierce, FL 34951
Property Tax ID p: 1301-605-0084-000.6 13114
Lot No.
Site Plan Name: Block No. 43
Project Name: RICHARD HARDERS RESIDENCE
DETAILED DESCRIPTION OF WORK:
INSTALLATION OF SOLAR PV SYSTEM TO ROOFTOP. REPAIR BENT UTILITY PIPE
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
X Electric _Plumbing _Sprinklers _Generator Pitch
_Roof
URBAN SOLAR GROUPXIMANDY LAWRENCE EC 13005324
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: S 30 Z 5(02- r 00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Richard Harders Name: MICHAEL VERGONA
Address: 5.909 Green Dolphin ST Company: URBAN SOLAR GROUP
City: FORT PIERCE State: FL Address:990 S ROGERS CIR STE 4
Zip Code: 34951 Fax: City: BOCARATON State: FL
Phone No. 561-609-2664 Zip Code: 33487 Fax:
E-Mail: PERMITTINGgDURBANSOLAR COM Phone No 5616092664
Fill in fee simple Title Holder on next page ( if different E-Mail_ PERMITTING@URBANSOLAR.COM
from the Owner listed above) State or County License CVC56948
ifvalue of construRion is 2500 or more, a RECORDED Notice of commencement is required.
If value of HAVC is $7500 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 now" or Instal latlon has commenced prior to the Issuance of a permit.
St. Lucie County makes no representation that Is granting a ppeermit will authorize the permit holder to build the subject structure
which Is In conflict with any applicable Home OwnersAssocfatlon rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Assoc latlon 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. Lccle County Amendments.
The following building permit applications are exempt from undergoing a full con currency 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 attornev before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF_PALMBEACH
Sworn to (or affirm d) and subscribed before me of Physical Presence or _ Online Notarization
thls,q=dayof�� 2021 by
MICHAEL VERGO
Name of person making statement.
Personally Known )�' OR Produced Identlflcatlon
Type of Identlflcatlon Produced
(Signature of No''t1a ub - f Florida )
Commission NoA Seal Lw
( )4 "'•VICTORIAWAONERMY COMMISSION#HH110A06
EXPIRES: April 5, 2025't°•' 0ondod Thru Nolzry Public Undewri:
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