HomeMy WebLinkAboutChecklist and ApplicationPLANNING & DEVELOPMENT
BOARD OF �._ .� � . � COUNTYtgj SERVICES DEPARTMENTDEPARTMENTx� v^
COMMISSIONERS �� r��
_y Building & Code Regulation
CHECKLIST FOR RESIDENTIAL/COMMERCIAL BUILIDING PERMIT
i� t006
Protect Location: davi� f a��� ��Date:
---- ;-/- �
Permit Dumber: Technician:
Required Documents:
Application completely filled out with Notarized Signatures ............................ Yes V No N/A
Sub Agreements with Notarized Signatures (prior to issuance) .......................... 'Yes ., a No ^ D/A_
Owner / Builder Affidavit (signed in office).................................................'Yes No N/A V1
Filled Land Affidavit (prior to issuance)................:.....................................'Yes / Do N/A
—
Recorded Warrany Deed, if applicable .........................................................'Yes No N/A V'
Recorded Notice of Commencemement (prior to issuance or inspection) ............... Yes— No N/AV
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 V No _ N/A
Truss Plans reviewed and approved by Engineer / Architect ............................ Yes / Do — N/A_
Landscaping and Parking plan (under 6,000 sgft)......................................... Yes No N/A
Approved Site Plans........................................................................... Y /
Yes Do D A
Sealed Survey with Dimensions, Finished floor ........................................... Yes V No — N/A
Elevations and Setbacks.............................................................. Y — / —
Yes No lit 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 (1 original signature) ....................................... Yes No N/A
Sealed Wind Load Compliance Certification ............................................... Yes c! No N/A
Product Review Affidavit..................................................................... Yes t! No N/A`
Other:
Health Department Permit Paperwork....................................................... Yes No N/A
CD for Fire Department if commercial or multi -family ................................... Yes No N/A
DEP, SFWMD or Army Corp of Engineers (dock, seawall, SF on beach)............ Yes _ No
PoolBarrier Affidavit.......................................................................... Yes No
Ground Sign Landscape Affidavit (signs) ................................................... Yes No
Burn Rate for Sign Cabinets.................................................................. Yes No
RV and Mobile .Home Tie -Down Only (2 codes)
N/A
N/A J
N/A
N/A
Permit Worksheet (Tie -Down Diagram) ................................................... Yes No N/A /
Manufacture Set -Up and Installation Manual .............................................. Yes No N/A J
�
Manufacture Blocking Documents..........................................................
Yes
No
N/A
�
Signed Penetrometer Test (1 copy).........................................................
Yes
No
N/A
Stair Details....................................................................................
Yes—
Y —
Nol�l
A
— / —
Mobile Home Inspection Report for Relocation (used only) ...........................
Yes
No —
N/A 'I
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
J
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
`--
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 :% x—y
PERM IT TYPE:S°;>
PRSED ffV1PROVENi,EI}NT.LOCATIOI\! /
rlrlracr � � j.7C2 e .i Y'1 ) Y.f1 0_ %' _P 's
J)r I. � �J E' V't'
Property Tax I D 4: Lot No.
Site Plan Name: /} 6 L=�'Ar� Block No.
Project Name: P/1 v i " i,i
i i(Y 1 i �'- L' (r •fi rAn e
Additional work to be performed under this permit — check all that apply:
'' Mechanical _ Gas Tank _ Gas Piping z�' Shutters 'Windows/Doors
Electric k!•Plumbing Sprinklers _Generator Roof 611JW Pitch
Total Sq. Ft of Construction: I Sq. Ft. of First Floor: Ord
Cost of Construction: On Utilities: —Sewer Septic Building Height: 17 ' 7 0 r>
OWNER/LE55EE' t f r ; N.7
CONTRACTOR _ =h
Name C\e_fgvr :, .e c� ��� ta,fa.,er f
Name: A�M 1 A_-.
Address: ° � � c ; •s :! ;''.�r1� €la�Gi'f.z,3i: �"fcompany:
>u f� �t e,cs
City: ,Cry ,� !C State:: .
Zip Code:'--1`,f / Gi 6, Fax: 1 7J, i i , `ice
Phone No.
Address: � `(? '^__��-4 l!r �a I , •s� i
City: State � FL
Zip Code:ka 4J-` c'6 Fax:'f
Phone No " ir. s �� : A,' c°,�
E-Mail: fi?!-oo �r At?�W& CrJ r ;7i .i=n� f;.ch� r�r
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E-Mail_}tas t_4�i
State or County License el'je_ 4z)_/,_, 1;,? L fit"
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.
_tPPl�liITAL,:CQi�SRl1CT1N:LiN:IA41�iiATl��9:
. ... . „�-i
f
DESIGNER/ENGINEER:
r 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 make no representation that is granting a ermit will aut�yorize the ermit holder to build the subject structure
which Is in conflict wit any applicable Home Owners Association rules, bylaws or anscovenants 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, 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
commencing work or recording your Notice of Commencement._
Signature of 0 er/ Lessee Contractor as Agent for Owner
Sign ure of Contractor/License Holder
�RIDA
STATE ®F FL
STATE OF FLORIDA
COUNTY OF SL I— U C-1 &
COIUNTV OF f Lc-) U
The forgoing instrument was acknowledged before me
this 17-dayof - :n-,r .2020by
V
The forgoing instrument was acknowledged before me
this � 7 dayof A�✓) i' 2026 by
II
1, i LYi Le (c,�
f,
, A.k iYlr -,
.`ill .
Name of person making statement
Name of person making statement
Personally Known -" OR Produced Identification
Personally Known L-" OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
) konax 'Pml
k K�
(Signature of Notary Public- State of Florida }
(Signature of Notary Public- State of Florida }
PUe R14ONDA8ROWE
Commission No. s° '"''•��`� mrni9slo4W104656
*
Commission No. ,�0POO RH0NDA�Q E
a # GG 1 4656
*
Expires May 18, 2021
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Commission
m� Expires May 1J, 2021
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Rev.8/2/17