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Home My WebLink AboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: • Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT TYPE: L PROPOSED IMPROVEMENT LOCATION: Address: =- 7,3 L 'q %h ,'l ; Permit Number: Building Permit Application Commercial Residential —�Z—/ Property Tax ID #: %C�(QQyd 9 Site Plan Name: Project Name: DETAILED DESCRIPTION OF WORK: 140c-e <;,16) CONSTRUCTION INFORMATION: Additional work to be performed under this permit -check all that apply: —Mechanical _ Gas T _ Gas Piping _ Shutters — Electric lumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ OWNER/LESSEE: Utilities: —Sewer _Septic Name /Ir- S f- i/;.,- - ^ / v Address: % 7 3 Ag/ City: F �r C r State:/!7z.. Zip Code.JZCT-/ Fax: Phone No.2'7„2 - / j'- © Z&= V E-Mail: W o'-?-� Fill in fee simple Title Holder on next page (if different from the Owner listed above) CONTRACTOR: Lot No. 31ock No. ,?R le — Windows/Doors _ Roof Pitch Building Height: Name: ' /-G C� ham.-- i ' u F.7 Compan Address: City: r FL - Zip Zip Code: Fax: Phone No E-Mail �s�%U1-7 State or County License (f",4-'7C p P-O& ' If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. SU PPLE -MENTAL CONSTRucTiON LIEN LAW INFORMATION Designer/Architect/Engincer: 0 Not Applicable Mortgage company. 0 Not Applicable Name Name Mailing Address City Mailing Address StateCity Zip Phone State Na me a Mailing m y C log Add, Mortgage Company: Address ,p s 0 Not Applicable zip — Phone A Fee SimPleTitle Holder's Name: 1-1 Not Applicable Bonding Company: 13 Not Applicable Name Name Miiiing Address Mailing Cat}` Mailing Address C State City Zip Phone _In State. Zip — Phone 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 hervbv made to obtain permit to do the work- and installations as indicated, I Celli fy 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, perform the work in accordance with the approved plans, the Florida Building Code 7th 1'.dition (2020) and Martin County Amendments. Plan revisions on all structures exempted by code from architect/cnginccr 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 fir I inspection. If you intend to obtain financing, consult with your lender or an attorney before Commencing work or recording Your Notice orCommelleell,cill. a that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning, Sk'nature of �=gtnalturc of Con iractl�—,-;r/License Holder 'on M STATIKOF FLORIDA STATE OF of COUNTY OVAIARTIN COUNTY OF MARTIN The tbl�g()Ing ImIrmicrit was acknowled before me Ilse fi going III, trurt-Writ Was acknowledged before Inc this 7."_ day of I A-. 200 ty this day CS)f—PoLq 20-1 by I Name of PCTWyI Acino_141—cdgin—g)- (Name ofYemo, ch �OTIA (Avlodgilo f 'u Std!W.JdP5iAA- state of F'onca ipall W�N IV lure ofNotary Public 4:! �Yvtl"r�riftbixc—Siatz-ol Melissa L Bullerreid -Ja Stamp Cot Melissa L Sutlerf* 30 or, il%tioilcd Niarrj�'� ' of Ex:wes 02114f2O23 if Pmonalfy Known 0i 1: Tip- of IdentificationPnAuced Personall) Knownto( 'ty pe pc (if ldcnfirjcati7un I'mduced (FI3C 7th Edition 2020) AD ...L%closure Statemen — 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 iyj�3t_-MWJIJAJLIL'Iae Rev. 06-21