HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^ O
Date: 3/9/16 Permit Number: (/J��U(
y. � RECEIVES:
Building Permit Application AUG 16 2016
PI mg evelopment Services
uilding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)46 1578 Commercial x Residential
PERMIT APPLICATION F To Select from dropbox, click arrow at the end of line
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Address: 7420 S. Ocean Dr. Jensen Bch, FL 34957
Legal Description: Sandollar Villas
Property Tax ID#: 3522-904-0000-000/6 � �� _ ('�(�� V�C1' Qot No.
Site Plan Name: Block No.
Project Name: Parking lot pole light replacement
Setbacks Front Back: Right Side: Left Side:
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31
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Replace(4)existing direct burial corroded&damaged concrete light poles& (8)light fixtures w/new fiberglass direct
burial poles&new fixtures w/turtle friendly light fixtures w/led lamps
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Additional work to fi
rorme un ert is permit—c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers El Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 22,000.00 Utilities:Sewer E]Septic Building Height:
Name Sandollar Villas Name: Michael Pettengill
Address:7420 S. Ocean Dr Company: Electrical Connections
City: Jensen Bch State:FL Address: 1209 SE Dixie Cutoff Rd.
Zip Code: 34957 Fax:772-229-0655 City: Stuart State:FL
Phone No.772-229-5352 'Zip Code: 34994 Fax: 772-283-5890
E-Mail:lkusen@aol.com Phone No. 772-283-5792 772-370-4394 cell
Fill in fee simple Title Holder on next page(if different E-Mail: mike@eleconnections.com
from the Owner listed above) State or County License: EC 13001494
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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Designer/Architect/Engineer: ❑ Not Applicable Mortgage Company: ❑ Not Applicable
Name Name
Mailing Address Mailing Address
City State City State
Zip Phone Zip Phone
Fee Simple Title Holder's Name: ❑ Not Applicable Bonding Company: ❑ Not Applicable
Name Name
Mailing Address Mailing Address
City State City State
Zip Phone 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 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,perform the
work in accordance with the approved plans, the Florida Building Code 5th Edition (2014) 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��&r/AjOet—e—ss Signature of Contfactor/UoKsAHolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MARTIN COUNTY OF MARTIN
The foregoing mstrume was ackr3bwledged before me The foregoing instrument was ackr}owledged before me
this day of o S 20_y this__ day of w 20_ZAy
(Na o rs Acknowle (Na c of Perso know edging.),
( ature of Nota Publi — ROBER./�p'� ture of Notary blit— to f Florida)
L 17WGf11�iM1
(Print,Type,or Stamp Commi of 8.�2 31 mfiri ,Type,or Stamp Commissioned ary Public WAY
138707
y; ., iSl N
Personally Known OR TiruN*r/PU* ally Known�OR Produced n
Type of Identification Pr used ype of Identification roduced � ilmdedllwuN 1'°��bk�
(FBC 5th Edition 2014)
Rev. 11/10115