HomeMy WebLinkAboutPERMITIN AUTHORIZATION FORM•Urb•aa
as ♦a
a s a s olar 990 S Rogers Cir, Suite 4
•s s•
• a a i
' Boca Raton, FL 33487
Florida License: 4 CVC56948 (888) 38-SOLAR
# EC13005324 info@urbansolar.com
PERMITTING AUTHORIZATION FORM
OWNER OF THE PROPERTY LOCATED AT ADDRESS:
DO HEREBY AUTHORIZE THE PERMITTING DEPARTMENT OF URBAN SOLAR GROUP, (KIMANDY
LAWRENCE) TO SIGN AND APPLY FOR A BUILDING PERMIT ON MY BEHALF. THIS AUTHORIZATION IS
VALID ONLY FOR THE PURPOSE OF OBTAINING A PERMIT TO PERFORM THE SOLAR INSTALLATION WORK
CONTRACTED FOR BY AND BETWEEN OWNER AND URBAN SOLAR GROUP. THE ONLY PERMIT(S) WHICH
MAY BE APPLIED FOR UNDER THE TERMS OF THIS LETTER ARE THOSE WHICH THE AUTHORITY HAVING
JURIDISCTION (CITY OR COUNTY) DEEM(S) NECESSARY UNDER THE CURRENT FLORIDA BUILDING CODE,
GIVEN THE SCOPE OF WORK CONTRACT FOR. URBAN SOLAR GROUP WILL BE RESPONSIBLE FOR ANY
AND ALL FEE ASSOCIATED WITH THIS PERMIT APPLICATION. THE AUTHORIZATION WILL REMAIN VALID
UNTIL SUCH PERMIT(S) IS/ARE ISSUED BY THE RESPECTIVE BUILDING DEPARTMENT, OR UNTIL ONE
HUNDRED AND TWENTY (120) CALENDAR DAYS FROM THE DATE LISTED BELOW HAVE TRANSPIRED,
WHICHEVER IS LESS.
MEOWNER SIGNATURE PRATED NAME DATE
VLAjq=:5<���
NOTARY AS TO WNE
VICTORIAWAGNER
MY COMMISSION # HH 113906
Sworn and subscribed before me this 2� day,
EXPIRES:April 5,2025 of 20� and [ ] is personally known or
FCF F=�•° Bonded Thru lolary Public Underwriters
yj produc d s identification.