HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
S u L-ur ct LL
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: o"" �uquina r viz run rierce, rL s4a01
Property Tax I D #: 1301-611-0094-000-8 Lot No.16
Site Plan Name: Block No. 105
Project Name: CONNELLY RESIDENCE
DETAILED DESCRIPTION OF WORK: I
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
Total Sq. Ft of Construction: I
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Cynthia R ConnellyJonathan M Reeves
Name: URBAN SOLAR GROUP/MICHAEL VERGONA
Address: 6905 Coquina AVE
Company: URBAN SOLAR GROUP
City: FORT PIERCE State: FL
Zip Code: 34951 Fax:
Phone No. 5616092664
Address: 990 S ROGERS CIR STE 4
City: BOCA RATON State: FL
Zip Code: 33487 Fax:
Phone No 5616092664
E-Mail: PERMITTING@URBANSOLAR.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail PERMITTING@URBANSOLAR.COM
State or County License CVC56948
-•••-� - -- •�•-�••�••�.�......, ,..�, a nca wnucv i.once or 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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State: _
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 at orne before commencingwork or recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF PAAM $tg_gh
Sworn to (or affirmed) and s bscribed before me of Physical Presence or— Online Notarization
this �- day ofJ 20�wt by
rni�PX-'rfy-g�
Name of person making staternefiV
Personally Known %< OR Produced Identification
Type of Identification Produced
:rid a
Signattfre of NotaryPublicState of Florida )
Commission No. CX7'-LZ
1_-Jroo (Seal) NOW" P.m,
Stephanie M Todd
y My Commua�on GO G46100
1 ExpasOVOW20Y4
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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