HomeMy WebLinkAboutScanned Document_04282021153700All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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
PERMIT APPLICATION FOR:
Commercial
Address: 13460 Harbour Ridge Blvd. Building 4 Unit 6B
Property Tax ID #: 4436-605-0030-000-7
Site Plan Name: Kozloski Residence
Project Name: Kozloski Residence
Residential X
Cap tub spout. Convert tub drain to shower drain, staying in same location. Install vinyl shower pan
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric -Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1,715.00
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer _ Septic Building Height:
Name Peter & Carole Kozloski Name: Donald Allex
Address:5134 Prices Creek Dr Company: The Plumbing Company of the Treasure Coast, Inc
p Y�
City: Southport State: NC Address:4390 SW Port Way
Zip Code: 28461 Fax: City: Palm City State: FL
Phone No.772-208-0190 Zip Code: 34990 Fax: 772-286-3315
E-Mail: Phone N0772-223-8688
Fill in fee simple Title Holder on next page ( if different E-Mail laurie@theplumbingco.net
from the Owner listed above) State or County LicenseCFC1425875
to LOVV VI 111MC, d RCI.VRutu rvoxice oT LOmmencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
,
NOW
DESIGNER/ENGINEER. _ 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 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.
Lucie County 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.
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StgtfaKre of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORA
COUNTY OF_ tJCkW IC1n
COUNTY OF 1 i ow
Shorn to (or affirmed) and subscribed before me of
Ph Presppce
S orn to (or affirmed) and subscribed before me of
sical or Online Notarization
this ` day of 202 by
Physical Prese ce or Online Notarization
this day of 12024 by
a4a
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known 4 OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
4
nature of Notary Public- Statejbf Florida) _
nature of Notary Pu i -
Commission No. ,,'<Y'i II�U IET.URY
WCOkwu''WION#GG3 33331
S�Ye?�; IAUR``Et URY
Commission No. _ �`. MYCOI
"a `= EXPIRES: July 16, 2023
t t ON # GG 3't3331
EXPIRES: July 16, 2023
REVIEWS FR NING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.