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® Resi lentlal / uoIY1mer iai .0UJJLUII g A VaB-RAJLGI
IS : ITE LU.CQ+Tf.®N
PE fV1IT NUMBER
TECHNICIA.iV
General:
Application completely filled out with Notarized Signatures ........................ .......
❑yes
❑ No
El N/A
Sub Summary list with contractors' names & county & state certification numbers..
❑ Yes
❑ No
❑ N/A
Agreements with Original Signatures ... I ..............
Sub Agr .............................
❑ Yes
[] No
❑ N/A
❑ Yes
❑ No
❑ N/A
Owner /Builder Affida....................................................................
Affidavit
Owner / Builder Electric Affidavit ............ I ...................
❑ Yes
❑ No
[l N/A
.
❑ Yes
C] No
❑ N/A
FilledLand............................................................. . ........
Affidavit
tY......❑
GEO or Recorded Warranty Deed . .
Yes
❑ No
❑ NIA
Recorded Notice of Commencement......................................................
❑ Yes
❑ No
❑ N/A
Utility Agreement or • • • ............................. .
Payment Receipt
❑ Yes
❑ No
❑ N/A
............................. ................... . ...
Vegetation Removal Permit.................................................................
❑ Yes
❑ No
❑ liT/A
Lot of Record ........
Non Conforming ..................................
❑ Yes
❑ No
❑ N/A
Plans, Calculations & Attachments (3 copies commercial 2 copies residential)
Complete set of plans with Engineer / Architect Raised Seal ....... . .............
Truss Plans Reviewed and Approved by Engineer / Architect ......................
and Parking Plans ..........
Landscaping ............................ .
Three (3) copies of Approved Site Plans ..........................................:.....
Two (2) Sealed Surveys or Plot Plans with Dimensions, Finished Floor ........
Elevation and Setbacks........................................................................
Yes No
❑ ❑
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑Yes ❑ No
N/A
❑
❑ N/A
❑ N/A
❑ N/A
❑ N/A
NIA
❑
Health Department Approval Stamped on Survey and Floor Plan ................
Health Department Food Establishment Permit Stamp on Floor Plan ............
Manual "J" or Manual "N" Calculations .........
Signed Energy Calculations .........................................
Sealed Wind Load Compliance Certification ...........................................
Product Review Affidavit ...................................................................
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ❑ No
❑ Yes ❑ No
❑Yes ❑ No
❑ NIA
❑ N/A
El N/A.
/
❑ NIA
❑N/A
page 1 of 2
esle " _ 1 / Cqm erclal B ildi 'ermit Checklist
I.SiTE COCA.TION
PERMIT NUMBER TECHNICIAN
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 ............................................
❑ Yes
❑ No
❑ N/A
Pool Barrier Affidavit........................................................................
❑ Yes
❑ No
❑ N/A
Ground Sign Landscape Affidavit.........................................................
❑ Yes
❑ No
❑ N/A
Bum Rate for Sign Cabinets............................................................... ❑ Yes ❑ No ❑ N/A
RV and Mobile Home Tie -Dolan Onlv _( � Copies) -
Permit Worksheet (Tie Down Diagram) .................................................. ❑ Yes ❑ No ❑ N/A
Manufacturer Set -Up and Installation Manual ............. I .............. .............. ❑ Yes ❑ No ❑ N/A
Manufacturer Blocking Documents......................................................... ❑ Yes ❑ No ❑ N/A
Signed Penetrometer Test ( I copy )........................................................ ❑ Yes ❑ No ❑ N/A
Stair Details.................................................................................. ❑ Yes ❑ No ❑ N/A
Mobile Home Inspection Report for Relocation ....................................... ❑ Yes ❑ No ® N/A
Copy of Title for Relocation.............................................................. ❑ Yes ❑ No ❑ N/A
Class "A" Approval from Growth Management ....................................... ❑ Yes ❑ No ❑ N/A
C:OIVIMENTS..
Name (PHntea)
Page 2 of 2
Signataare Date
Detail
Date Printed
07/21 /2022
04957
Work Order #- 04957
Title: BR 1169 1309-0097
Origin: Non -PM
Cost Center.
Priority: Medium (3-7 days)
Problem:
Originated: 07/20/2022 04:18:00 PM
Expected:
Work Category: Warehouse
Address: St Lucie, FL
United States
Work requested:
BR 1169 1309-0097'
Action Taken:
Comments:
Total Labor Cost
Total Part Cost
Equipment Usage Cost
Total Other Cost
External Labor $:
Non-inv $:
WO Cost
None
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Page 1 of 2
Source Type: Location
WO Status: New Request
Originate: Melissa Brubaker
Project
Work Type:
Assigned
Completed:
Total Labor Hours:
Total Other Hours:
Total Hrs:
EmpWee # Name Job Title Phone Email Est Hrs Company Name
1 Matthew Rector 772-204-5221 rectorm@sUucieco.org 0.00
2 Luis Dominguez-Saiguero 772-204-5221 dominguez- 0.00
saiguerol@stiucieco.org
Name Location # Path Site Description
Building and Code 2000000017 Admin Complex II (Virginia Ave.) > Building and Code Facilities [N/A]
None
None
Im
None
M.
None
0.00
0.00
0.00
None ,
ti
SCANNED
8Y
St. Lucie Covnly