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Date: 9/20/2021 Permit Number:
O
G ` ., ` L` t1 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78
PERMIT APPLICATION FOR: Replacement Of Windows & Doors
PROPOSED IMPROVEMENT LOCATION:
Address: 4005 Greenwood Dr Fort Pierce, FL 34982
Property Tax ID #: 2421-702-0035-000-8
Site Plan Name: Kolosick
Project Name:
XXX
Lot No. 2
Block No. 2
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Replacement of Windows & Doors
FL NOA 21-0608.03 FL NOA 21461.1
FL NOA 22250.1 FL NOA 22645.1
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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 Ccnstr,,ctinn• t 16.000.00
Cost .... ...... �...� u.,....... y
Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
I Iti �iticr Sealer Septic Rr,ilr�inrt I-loirt4�t•
OWN ER/LESSEE:
CONTRACTOR:
Name Justin & Natalia Kolosick
Name: Jeffrey Walsh
Address: 4005 Greenwood Dr
I Company: Liberty Impact Windows and Doors
l,lty: Ft PicrrA _ Sldle: _
Zip Code: 34982 Fax:
Phone No. 239-963-6061
Addre5ss:257 SE Monterey Road East
City: Stuart State: FL
Zip Code: 34994 Fax:
Phone No772-444-7112
E-Mail7 libertypermitting@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
E-Mail libertypermitting@gmail.com
State or County LicenseCGC 1528257
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/ENGINEER: X Not Applicable
Name:
MORTGAGE COMPANY: �( Not Applicable
Address:
Name:
City:
Address:
Zip: Phone State:
City:
State:
FEE SIMPLE TITLE HOLDER:ApplicableBONDING
Zip: phone:
Name: — Not
COMPANY:
Address:
Name: Not Applicable
City-
Address:
Zip: Phone:
City:
Zip: Phone
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation '
I certify that no work or installation has commenced prior to the issuance of a permit.
as indicated.
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 r
structure. Please consult with your Home Owners Association and review our deed for an restrictions which may apply.
y y y restrict or prohibit such
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 JOB SITE�RE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
RICXJWC
WITH YOUR LENDER ANEY BEFORE RECORDING YOUR VOTICE OF COMM
-"
Signature of ner/ Lessee/Contractor as Agent for Owner I-= Signature
STATE OF FLOFGDA
COUNTY OF CI E
ThLee
s en was acknowledged before me
thif r r 20 Z !! by
Nan mak!Zji g statement.
Personally Known 4 OR Produced Identification
Type of Identification
Produced
n
(Signature of Notary Public-
��jj Notary Public State of Fonda
Commission Nb I p��(1ie Sp"idin
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a n Expires 10/27/2024
REVIEWS I FRONT I ZONING
i COUNTER , REVIEW
DATE
RECEIVED
DATE
COMPLETED
ctor/License Holder
STATE OF FLOR
COUNTY OF I P
The forgoing instr men as a`fknowledge before me
this � d of f YC l by
Name of person maki statement.
Personally Known -/_ OR Produced Identification
Type of Identification
Produced
ignature'of Notary
CC-:)i—( Jj(
mmission No.
SUPERVISOR I PLANS I VEGETATION
REVIEW l REVIEW REVIEW
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l2 Stale of Florida
SNSpuAin
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SEA TURTLE I MANGROVE
REVIEW , REVIEW