HomeMy WebLinkAboutBUILDING PLAN APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �al�l I� Permit Number:
e 77
Building Permit Application DEC 2 8 2011
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Building
Address: ✓ cy ' «-+���-Y . 11�=
Leg , /Description:
I1. P/L%Ij�P d �T'7-
Property Tax ID #:
Site Plan Name:
Project Name:.
Setbacks Front Back: SSA. Right Side:
Aloe-Z41 r� X"_ % � T r� d5v
Electric F-1 Plumbing �r Z ]Sprinkl
Total Sq. Ft of Construction: o36l� r U 5�4
Cost of Construction: $
- /'sL� 1/6
CQ Lot No. /3
Block No.
SA
ers 1:1 Generator Roof
S Ft. of First Floor:
Utilities:cnSewer nLJSeptic Building Height:
Roof pitch
'v da+i Q..y .,r.,i tf- "; d; �'+.y1 Nsj' f$�r'S✓�'} -,D } "..^` �``5� 2,!" .S�;
�OUNER/€€LESSEE '� �� z�
Mil � fi � .a?.: ' S"
%w`�•i'�
CONTRAGTO,R �; F
Name aJaAH MWIdW
Name: o�
Address: W 2 1 le-&&
Company:
City: d4e-!' State:,-2-
Address:
Zip Code: ✓��'7— Fax:
City: State:
Phone No. !7/72-"V � I — d 913
Zip Code: Fax:
Phone No.
E-Mail: 770,VM(0 SC%A,4&!%• COM
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
x J
SUPPLEMENTAL GONSTRUCTION> LIEN LAW INFORMATION
a
DESIGNER/ENGI EER: t
�.Ii�1
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: ��
Name:
Address:
Address:
City:
State:
City: 'P _State: �L
Zip: 32 g !71 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 madeto obtain a permit to do the work and installation as indicated.
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 inaction. If you intend to obtain financing, v consult w' lender or an attorney before
commencing aft Or recording vour Notice of Commencement.
Ow er/ Less Coa/act as Agent for Owner
gna re of ontract /Li older
/SA/
FLORID
LZL
ATE OF FLORIDACOF
OUNTY OF
..{
-� C e
The for Ing instr ment was acknowledged before me
day 20� by
The for oing instr ment was acknowledged before me
thi�ay of 20J by
of
�
V l
Name of person aking statement
Name of perso aking statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Signatur of otary Pubic- State of Florida)
(Signature of otary Public tate of Florida )
Comm'
, �►^�V�%" Ya N MATONTI
Commission (Seal)
:;�ti'`'r" MARYANN
:.: MATONTI
'e MY COMMISSION # FF953138
MY COMMISSI
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RES Jan
nuar 2 , 2102
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REVI
SUPERVISOR
PLANS
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GROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
c u ::fir
VIEW
DATE
�/
RECEIVED
I
d
DATE
��� 8•
COMPLETED
tev. 8/2/17
ELEVATION CERTIFICATE
OMB No. 1660-0008
Exolratlon Date: November 30.2018
IMPORTANT: In these spaces, copy the corresponding Information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) of P.O. Route artd Box No.
Policy Number.
5802 HICKORY DRIVE
City state ZIP Code
Company NAIC Number
FORT PIERCE Florlde' 34982
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRE)
C1. Building elevations are based on: ❑ Construction Drawings" [] Building Under Construction' ® Finished Construction
*A new Elevation Certificate wifl be required when construction of the building is complete.
C2. Elevations — Zones Al-A30, AE, AM, A (with BFE), VE, VI--V30, V (with BFE), AR, ARIA, AR/AE, ARIA1 A30, ARM, AR1AO.
Complete items 02.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: CO am Vertical Datum: NAVD 1988
Indicate elevation datum used forthe elevations in items a) through h) below.
Q NGVD 1929 ® NAVD 1988 ['] Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used,
a) Top of bottom floor (including basement, crawispace, or enclosure floor) 19.8 2 feet ❑ meters
b) Top of the next higher floor 20. 2 feet
� ❑meters
c) Bottom of the lowest horizontal structural member (V Zones only) WA. [] feet meters
d) Attached garage (top of slab) 19 8 ® feet ❑ meters
9) Lowest elevation of machinery or equipment servicing the building is, a ® feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 19. 5 ® feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 19. 7 ® feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including NlA . feast j] meters
structural support
SECTION D —SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation informatlon.
1 cerW that the lnfoffnadon on this Cerdicate represents my beat efforts to intwprot the data available. I understand that any false
statement may be punisha6la by tine or imprisonmant under f 8 U. S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? R Yes ❑ No ❑ Check here if attachments.
Casrtilrei's Name license Number
_
MARK W. TEEPE 4817
Tide
P-S.M.
:.
company Name
CORNERSTONE SURVEYING
. ":tip
\
Address
325 SW SOUTH QUICK CIRCLE
City to ZIP Code
PORT ST. LUCIE Florida 34958
Signature Date Telephone
u! . f ,6 717241 ame
Copy all pages of this Elevation Certificate and all attachments for (1) oo1nmunity official, (2) insurance agent/company. and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
Equipment description In Sea C2(e) = air condt. unit
Finished floor deser bed in Sec. C2(a) =19.8', which is a florida room addition.
The finished floor of the house is 24" above crouvn of road.
The finished floor of ttse addition is 22" above crown of road.
rt:mA corm tree-u-33 (7I75) Replaces all previous editions. Form Page 2 of 6
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