HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COh- ETED FOR APPLICATION TO BE ACCEPTEu r�
Date: Permit Number:
RFD
Building Permit Application k-M. ?4V%B
Planning and Development Services a .,..
Building and Code Regulation Division L°che cloud^ty ent
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Renovation
PROPOSED IMPROVEMENT LOCATION:
Address: 12623 S. INDIAN RIVER DR., JENSEN BEACH, FL 34957 SCANNED
Legal Description: 4504-310-0005-000-6 St. Lucie County
LONG LEGAL (ATTACHED)
Property Tax ID #: 4504-310-0005-000-6 Lot No. 6
Site Plan Name: Spring Hill Block No. 2
Project Name: DiLorenzo Kitchen Remodel
Setbacks
Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK: I
Kitchen remodel, replace one window, relocate plumbing
CONSTRUCTION INFORMATION:
itiona wor to e e orme under t—checkispermit a apply:
❑HVAC 11 Gas Tank ❑Gas Piping In _ Shutters Windows/Doors
❑ Electric ✓❑_ Plumbing []Sprinklers❑ Generator ❑ Roof ❑ Roof pitch
Total Sq. Ft of Construction: 210 SF
Cost of Construction: $ 6500.00
S Ft. of First Floor: 2136
Utilities: Ft
❑Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name EVA TAKACS DILORENZO
Name: RICHARD P DUFFIELD
Address:12623 S. INDIAN RIVER DR.
Company: SUNSTATE CONTRACTORS LLC
City: JENSEN BEACH State: FL
Zip Code: 34957. Fax:
Phone No.912-617-0949
Address: 2697 SW DOMINA RD.
City: PORT ST LUCIE State: FL
Zip Code: 34953 Fax: 407-241-8662
Phone No. 772-224-2793 OFC. 772-215-4156 CELL.
E-Mail: EVA—DILORENZO@YAHOO.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: RICKY.DUFFIELD@GMAIL.COM
State or County License: CBC 1261719
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 vour Notice of Commencement. A ^ /\
Signature of Owner/ Letee/ConitActor as Agent for Owner
Signature of Contractor/Lic nse IF older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF SAINT LUCIE
The forgoing instrurnprit was cknowlecigee,d before me
0eOL N
The forgoing instrument was acknowledged before me
Ze NOVEMBER by
thiss _-Jq day off by
this day of 20_
^ 1 _U
EVCS ^ & Lrtn t7o
FN
TT VA
RICHARD P DUFFIELD
of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known xxxx OR Produced Identification
Type o en I (cation
Type of Identification
Produced
Produced
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(SignaturNQb
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BIANCA FATHAUER
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Commisslon M GG 037008
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Commission �' Public - State�Oi��lorltla
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Dec 20. 2018
NS My Comm. Expires Oct 6, 2020
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Nationai Not
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Rev.8/2/17