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All APPLICABLE INFfJ MUST BE CIZ...7:MD FOR APPUCATIQN.TO BE ACCEPTED
� r )�Date. .1. Perm"it,Number lJ _�
,` JI � '
BLUOEBEAM
Building Permit"Application
Atonning:atid DetietbpmenE Services
Bul%fingand Code:Regulat on Dfviston: COrY1i1'12FC1 �_ f kSidential
.
2300 itrgiri a Avenue,Fort.Pleree.FC.34992
-Phone 1772y 4614553 Fax: (772)462-1578'
, . KOFPERF PPL OR.i
Address.:5703 MYRTLE DR FORT PIERCE, FL 349g2
Property-Tax i# 3402=609 0302=000-9 �000: 24
SlmflOrl Name:.. ......_ _ .... Block No 60:
Project Name: SAMPSON; DAVID.
r^s t C-va`:- " .z x::i z ' s '��t^` ;it\ .Y. �..^.Y}. ,-•'- .,a. 'f s rs �.
ROOF.'MOUNTEUSOLAR.PV SYS.TW INSTALLATION, '10.44-KUV -
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N,eW ElectiicAi Meter •Second,Electrical Meter (Affidavit:required)
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Addit,onai,Work-.to.'be performed under this�permit—check all ttrat appij
Mechanical _Gat.Tank _.Gasfiping _Shutters Windows/Doors: _Pored
Electric: _Plumbing _'Sprinklers Generator _Root Ptiteh
Total Sq Ftof Construction;` . Sti Ft:of �rst Hoor
-
- -
27 666 OQ- - _ 40
Cost of"Construction•$ .. Utiirties , _S�wer'.__:S ptic S IdingrHeight:
Ow 11
us
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'Name_DAV(D::SAMFSON; _ Name NQRMARI E.PURKEY. ,
Address: 5703,;MYRTLE DR. Company-SOLAR BEAR:LLC:
;City" FORT PIER. CE State: r�, Address 4091 AMTG CENTER DR . ,
........... .. .
Zip code 34982 Fax: City: L .APWATER state FL 1
,Rhone No: f7041 524=8 1 53 zip Cede 33764 Fax
E Marl:. dayi.eboY014�gtltad Com, <PhoneNo727-471 7442
- - _ _.
Fill in fee simple Title.Holder.an next page(if different E=Mail
�lOET�.OURSOLARBEAR,COM
from the.Owner listed: abeve) state or County LicenseEC130066.30' ,
If value of construdion is 200 or mere,a RECORpED Notice of`commencement is required.
If value of HMOs'$7,500 or more,a:RECORDED Notice of CoOiMencementas-required.
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DESIGNER.ENGINEER; Not;Apphcab{e MORTGAGE COMPANY.: Not AQphcabte, .
Namea
Address Address
at .. Stater
r Phone Zip Phone
FEE,SiMPLETITLE'HOLDER: �„.Nat.Apphcable BONNameDING COMPANY; iNot Applicable
Address:... Add�ess
_
c
city. ftr
Zips Rhone; Zjp Phone:
,-OWNER/CONTRACTOR AFFlDVIT.Application is hereby made to obtain a permit to do;the work,and iri5tallatiort,as,indicati
I certify-that_no work orinstallation hascommenced prior to the issuance of a permit,
5t:tude Count�yy makes no represeritatiot that--ls;grantipg a.pefmit wlllauthor"ize tie ermit holder to bu►td theaub�ectstructure.
which is in.conffict::with ar" applicable HorimeyQv4rners,,Association rotes,bylaws:or and.covenants<that�rtiay.restrict or prohibit such'
strueture.:Rlease ccnsult_w�th gout Home Owners Association andreuiew youir:deed forany restrittianS whlc#t.riiay apply:;
In consideration of:the granting ciftth�s requested;permit,_I d.,hereby agree tha-J wall,iit all respects,perform.the wank
t►?accordance with>the approved plans,the,Ffor'ida:BuildingCades:and:St.Lucie Cbunty Amendmentsa=
The:fopowing;building permit applications are exemptfram undergoing a full concurre-hq rev enr room additions,
;atcessorys rucEures,swimming pools,:fences;:wails,signs,screen3raoms and_accessoryum to another non residerifia!use
1NARNtNG TO OWNER.Y'aur failure to Record a:N m ....of Comnnenc+ement inay result In paying twice for
improvements to your property A Notice of Comtnencelrierttust be reco'tded th the public:records of St.:
Wdbx,6unty and posted on the�abstte before the frst inspection.If you intend to obtain financing,consu.It.
:with'te Wer orari.:atturne, -before.cornmencin work or:recoedin our Notice of to, mmencement.
Signature of O JContractnras Agent for Owner
STATE:of FLO:RI
cooNTY ofr
Sworn to{or affitm d)and s bscribed hefore me of Physical n{m
,Presence or, Oe Notar�zat%oq
:_
thls,,� day;of.
tea eqpqrtoijmaking;, atement:
_ Persona.l.ly Known ORProduced identification;
Type ofi ntificat ° `ducad
ign ture Ndtary PUbIfc-5tatevf Florida`):
[ommr5s�on No. /f/,�y'r!o'} . . {Seal] - Joseph Tnbou
Notary Public,State:of-Florida
My Cornmisslon:,Expiies12/QMW4
commarsio No.HH899QZ`
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REV{EW REVlEV11 RE1/IE1ilJ REV,I.EW REVIEW REVIEW
DATE
RECEIVED
DATE,.e....
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