HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: // Permit Number: �-���J
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (71 2)462-1553 Fax:(772)462-1578 Commercial Residential
! PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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P1OPOSEO "'WO to +
Address:
Legal Description: Lake.5 I Dlo- 111 • Lot) ( - ODD - ['
Property Tax ID#: I3010-I,/I" DDDI- Obo-0 Lot No.
Site Plan Name: /� )' Block No.
Project Name: L/�Skoosk 1
Setbacks Front Back: Right Side: Left Side:
ETAILEDDESCR1PTItNflF WORM iK
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CONSTRUCTIaN INfORMAT
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Additional work toe e orme under t -Checkispermit a appy:
❑HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers 1:1Generator Roof Roof pitch
Total Sq. Ft of Construction: /. �[1 d Sq. Ft.of First Floor:
Cost of Construction:$ �i`7 73 Utilities: _Sewer Septic Building Height:
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Name
C0IUTRACOR r�&
Name lly�ely iSlLouY/Ci Name: 1497.
Address: 6�/e o/e CWdra Company: or .,�,c -
City: State:/4 - Address: Z.W
Zip Code: .3ef"5 Fax: City: C cel State:,�
Phone No. 777-- r/86 //6-5 Zip Code: ✓L9.z Fax:3Z/G3�'0397
E-Mail: Phone No. YZ/ VU 4 ,53 /
Fill in feesimple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 361
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEI�I COI NSTRUCTION L1E'N LAW'.',I RMA�TIOt� ��� � X
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY, _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: ' Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
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 Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing ork or -cord' our Notice of Commencement.
Si to wrier/ essee/Contractor as Agent for Owner Sign re of Contra'dorYD06nse Holder
j STATE OF.FLORIDA STATE OF FLORID►
i COUNTY OF u -etlnd COUNTY OF
;i
The forgojng instrument was acknowledged before me The f�goi.g instru nt was acknowledged before me
this ��—day of�iirrr,'Q 20/�by this /lay of 20Ifby
� �i��r-� �d�cid 5�—v� IU�r�ie./c✓
Name of person making statement Name of person making statement
Personally'Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
7( nureof Notary Public S (Sig re of Notary ublic tat
JANINE SCAPICCHIO ;`►*vP;;; JANINE SCAPI 10
sion No. :�' .: MY AISSION#GG0409 0 ission No. {5goboMMISSION#G 30 1,0900
EXPIRES October 23,2020 =4 MW
` EXPIRES October 2 . 20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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TRINITY I ERD
8. MANUFACTURING PLANTS:
Contact the noted QA agency for information on product locations covered for F.A.C. 61G20-3 QA requirements.
} The following plants have qualified products under their respective physical properties specifications.
i .r. -� .t.:ta,,• 5�)el»ifiCltoll," -w"`` '�'�'`- },'��`� prOdul': s✓°."i�5�; '��k�'� v tri-iS.h.��'r#z3.�.�resjtp,�,4�`�� �taa;:•+.�c'�'�,'"�e�s:.:.''•,;
Lastobond Shield,RESISTO SA SMOOTH PLY 40,Lastobond Shield HT,
Lastobond Pro HT-N,Lastobond Pro HT-5,Lastobond 195,Lastobond
Drummondville, Lastobond
D1970 Eaves Protection Sheet,Lastobond Eco,Lastobond Smooth Seal HT,
QC(Canada) RESISTO L81236,PrimeSource Grip-Rite Eave&Valley Protector,
I
RESISTO LB1244
ASTM D1970&FRSA/TRl 04-12 Colphene FR GR
Wadsworth,OH Lastobond 195,Lastobond Eaves Protection Sheet,Lastobond Eco,
ASTM D1970 Lastobond Smooth Seal HT,RESISTO'LB1236,PrimeSource Grip-Rite
Eave&Valley Protector,RESISTO LB1244
ASTM D1970&FRSA/TRI 04-12 Lastobond TU HT;Colphene FR GR
Gulfport,MS - Lastobond 195,Lastobond Eaves Protection Sheet,Lastobond Eco,
ASTM D1970 Lastobond Smooth Seal HT,RESISTO LB1236,PrimeSource Grip-Rite
Eave&Valley Protector,RESISTO LB1244
9. QUALITYAssURANCE ENTITY:
UL,LLC—QUA9625;(314)578-3406;"k.cHi ncelior@tis.ul.com
-END OF EVALUATION REPORT-
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Exterior Research and Design,LLC Evaluation Report S18010.06.09-1111CertificateofAuthorizadall#95o3 6T"EDITION(2017)FBC NON-HVH2 EVALUATION F1.2569-1133
Soprema,Inc. Revision 11:10/06/2017
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