HomeMy WebLinkAboutChecklist w ApplicationBOARD PLANNINGDEVELOPMENT
S�T LUCE ��«- -
COUNTYr.
SERVICES DEPARTMENT
COMMISSIONERS
Building & Code Regulation
CHECKLIST FOR 1PERMIT
Project Location: tA dO �-�-)Y"g- �� Z CYv
f "P Date:
Permit Number: Technician:
Reauired Documents:
Application completely filled out with Notarized Signatures ............................ Yes V" No — N/A
Sub Agreements with Notarized Signatures (prior to issuance) .......................... Yes V No N/A —
Owner / Builder Affidavit (signed in office) ................................................. Yes_ No _ N/A
Filled Land Affidavit (prior to issuance)......................................................Yes V/ No N/A
Recorded Warrany Deed, if applicable....................................................... Yes_ No — N/A
Recorded Notice of Commencemement (prior to issuance or inspection) ............... Yes— No _ N/A
Utility Agreement or Payment Receipt (prior to issuance) ................................. Yes_ No — N/A_
Vegetation Removal Application with copy of survey ..................................... Yes /No _ N/A —
Plans. Calculations & Attachments ( 3 copies commercial, 2 copies residential)
Complete set of plans with Engineer / Architect Raised Seal ........................... Yes No , N/A
Truss Plans reviewed and approved by Engineer / Architect ............................ Yes No N/A
Landscaping and Parking plan (under 6,000 sgft)......................................... Yes_ No — N/A
Approved Site Plans........................................................................... Yes ✓ No — N/A
Sealed Survey with Dimensions, Finished floor ........................................... Yes `� No N/A_
Elevations and Setbacks.............................................................. Yes V11 No _ N/A
Plot plan with Setbacks............................................................... Yes V/ No N/A.
Health Department approval stamped on survey and floor plan ........................ Yes— No — N/A
Health Department Food Establishment Permit stamped on floor plan.... .......... Yes— No — N/A
Manual "J" or Manual "N" Calculations ................................................... Yes No N/A
Signed Energy Calculations (I original signature)... . ............... ......... ......... Yes v/ No — N/A
Sealed Wind Load Compliance Certification ............................................... Yes / No N/A
Product Review Affidavit ............................................................. ....... Yes V No N/A
3171, "1011
Health Department Permit Paperwork ....................................................... Yes—
No
N/A
CD for Fire Department if commercial or multi -family ............................ I .......
Yes—
No
N/A
DEP, SFWMD or Army Corp of Engineers (dock, seawall, SF on beach) ............
Yes—
No
N/A V
Pool Barrier Affidavit... ............. .......... ....... ...................... _'.
Yes—
No
N/A
Ground Sign Landscape Affidavit (signs) ...................................................
Yes—
No
N/A
Bum Rate for Sign Cabinets ..................................................................
Yes—
No
N/A
RV and Mobile Home Tic-D (2 copies)
Permit Worksheet (Tic -Down Diagram) ................................................... Yes— No N/A
Manufacture Set -Up and Installation Manual .............................................. Yes— No N/A
Manufacture Blocking Documents .......................................................... Yes— No N/A
Signed Penetrometer Test (I copy) ......................................................... Yes— No — N/A
StairDetails ....................................................................................
Yes
No
N/A
Mobile Home Inspection Report for Relocation (used only) ...........................
Yes—
No
N/A
Copy of Title for Relocation (used only) ...................................................
Yes—
No
N/A
Private Property not in a mobile home park
Class "A" Approval from Planning or file # ................................................
Yes—
No
N/A
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
P fF
.54
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: -5 nle_ J
PROPOSED] M PROVE M ENT LOCATION.
Address: ,U0
�1
0 YV\ P)re-z' z P--s-,
be- Fr�v_-v pt'-Ce.6,
Property Tax ID #:
CDf -000-7 Lot No.
Site Plan Name:
Block No.
Project Name:
PAL _:Iiu
A
K-7-101 I- i1l 0 s—&
CONSTRUCTION ]WIRMATI
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank Gas Piping 'v" Shutters Windows/Doors
Electric v"Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: 9) Sq. Ft. of First Floor: /6-1 74
I
Cost of Construction: $ Utilities: Sewer / Septic Building Height:
OWNER/LESSEE • _
CONTRACTOR::
Name- 1L�
Name: 0�,:J i-\
t.
Address: IJ
V
'Company: L(_-,
City: State:
7
Address:.--,7 ', _,_J5
city:
State:! R_
Zip Cocle:`-3`-/ c:1 Fax: 2 72— /,;ci;
Phone No. "IL'I, Znc-,LL -ZAL_-,'v �J-
Zip Code fFax:
Phone No
",-`
E-Mail: C,
Fill in fee simple Title Holder on next page if different V
E-Mail 1v
S. 6417
State or County License
A,_J_,f
from the Owner listed above)
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.
$UPPLEMENTAL CQNSTRUCT10N II_N LAW INE0RMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE MOLDER: 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 1 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, wails, 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
commpncin¢ work or recording your Notice of Commencement._
Signature o IOwner/ Lessee/Contractor as Agent for Owner
Sign ure of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF t_° Zy o e_
COUNTY Of 61 Lu 0 e-
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of a �� tY� _' . 20?� by
this ilt�i day of t . 20 by
aA
I5A Ill. �E�
l��i%.�1�► { AV
Name of person making statement
Name of person making statement
Personally Known `� OR Produced Identification
Personally Known i,� OR Produced Identification
_
Type of Identification
Type of identification
Produced
Produced
kk,,d&)
(Signature of Notary Public- State of Florida )
�u„� RHONDAS ROWE
(Signature of Notary Public- State of Florida)
ROWE
µY P(/R RHONDAS
Commission No. =°�P'' ''i4c, CommijgmaoGG104656
*
Commission No. `r`, Commis g AG104656
f7,z Expires May 9, 2021
* Expires May 19, 2021
��1 Bonded ThruBudget Notary services
','nded Thru Budget Notary Services
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Rev. 8/2/17