HomeMy WebLinkAboutKosloski Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,ZA :�c-�ZL�
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
property Tax lD #: °`°�,° C� Lot No.
Site Plan Name:y Block No.
Project Name: -
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter p Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping Shutters Windows/Doors _ Pond
Electric Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:��
OWNERAESSEE:
CONTRACTOR:
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Add resslk
City: State: State:4
Zip Code: Fax:
Phone No.
Company: e ��
Address: @� n
City: Cti:. � � � � �i ,. State' --
Zip Code:-2 �._� Fax:
PhoneNow-A-
E-Mail:
Fill in fee simple Title Holder on next age ( if different
from the Owner listed above)
E-Mail e=i-c�3,,
State or County License p_,..�:.
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINES : _ Not Applicable
Name: 1
Address:
City: State:
Zip: Phrn6 s
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: P ; ne.
FEE SIMPLETI !E HO 11)Ek.9 Not Applicable
Name:
BONDING P Nl � Not Applicable
Name: i
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
L cie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
th lender or an attorney before commencing work opirecording your Notice of Commencement.
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Signa ure o wne Lessee/ ontractor as Agent for Owner Signature of Co tra or/License Holder
STATE OF FLORIDA
COUNTY OF is
-I&rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this � ay of w:,1A . 2024 by
STATE OF FLORIDA
COUNTY OF_",,p,I-� KD
warn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this ay off-KLi, 2021 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification_
P r c�tee
S
(signature of Notary Pub -,State of Florida )
Commission No. �aPyG�., (SeaqONNIE LOV`T'
4 MY CommiSSION # GG1,
Personally Known OR Produced Identification
Type of Identification
Prgced A
(Signature of Notary Public- State of Florida )
mission No.
E3C(NbIJiq L.OVITT
MY COMMISSION # GG143436
REVIEWS FRONT PLANS VEGETATI
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED