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HomeMy WebLinkAboutBuilding permit appALL APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: - Permit Number: R - Building Permit Application Planning and Development services Building and Cade Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED; IMPROVEMENT:LOCATION Address: 4:-(c— � � (�pS Legal Description: Property Tax ID #: c4= 2 _ Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: -PETTAI.LED DESCRIPT 0N,OF WORK: 7-0 tON-TRUCrloN INFORMATLON� _ na wo to a orm Fander is perm — check all t= apply: HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors Electric 0 Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: . Ft. of First Floor: Cost of construction: $ )- '� Utilities�Sewer Septic Building Height: � E i3 OWNER/LESSEE; C4� Name___. � c �rr-� G�� 'i--D Name: �C Address: 1 �4 --d ` 2 3 f '` G— S e Company: City: ; State: Address: S _ °r Zip Code:_3 1 Fax: City: State: )C:e- Phone No. -. 3� - ' Zip Code: 3S'„ Fax: E•-Mail: Phone No. _?").)- - L L-3_� Fill in fee simple Title Holder on next page ( if different E-Mail: L�;,, from the Owner listed above) State or County license: ll C orr� ff value of construction Is $2500 or more, a RECORDED Notice of Commencement is required. Designer/Architect/Engineer: Name Mailing Address City Zip Phone © Not Applicable State Fee Simple Title Holder's Name: © Not Applicable Name Mailing Address City State Zip Phone Mortgage Company: Name Mailing Address City Zip Phone Bonding Company: Name Mailing Address City Zip Phone ❑ Not Applicable State Q Not Applicable State Notice to Owner: There are some properties that may have deed restrictions recorded upon them. These restrictions may limit or prohibit the work applied for in your building permit. It may be to your advantage to check and see if your property is encumbered by any restrictions. Owner/Contractor Affidavit: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perforce the work in accordance with the approved plans, the Florida Building Code 6th Edition (2017) and Martin County Amendments. Plan revisions on all structures exempted by code from architect/engineer design may be done by permit holder. Warning to Owner: Your failure to record a Notice of Commencement may result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the job site before the first inspection. If you intend to obtain financing, consult with your lender or an attorney before commencing work or recording your Notice of Commencement. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Signature of Owner/Agent(Lessee STATE OF FLORIDA COUNTY OF MARTIN The foregoing instrument was acknowledged before me tbis 1.)r day of =—L. / , 20-X�by 7_ L. �— to , L_ —L (Name of Person Acknowledging) (Signature of Notary Public - State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known OR Produced Identification f� Type of Identification Produced (FBC 6th Edition 2017) of Contractor/License Holder STATE OF FLORIDA COUNTY OF MARTIN The fangoing instrument was acknowledged before me Ws _�� day of _ �i^C 1% ( 20�y (Name of Person Acknowledging) (Signature of Notary Public - State of Florida) (Prink Type, or Stamp Commissioned Name of Notary Public) Personally Known 4.�Olt, Produced Identification Type of Identification Produced ADA Accessibility Disclosure Statement -- This document may be reproduced upon request in an alternative format by contacting the County ADA Coordinator (772) 320-3131, the County Administration Office (772) 288-5400, Florida Relay 711, or by completing our accessibility feedback form at www.martin.fl.us/accessibility-feedbaclr. Rev. 01-19