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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
N3-n.r••y. is
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Building Permit Application
Planning and Development Services DEC 2 6 2018
--Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION.
Address:,.6815 Dickinson Terrace Port Saint Lucie FI 34952
Legal Description: OLEANDER PINES BLK 1 LOT 43
Property Tax ID#: 3415-705-0044-000-7 Lot No.43
Site Plan Name: N/A Block No. 1
Project Name: N/A
Setbacks FrontNiA Back: NIA Right Side: N/A Left Side: NIA
DETAILED DESCRIPTION OF,WORK
Remove existing roof shingle and underlayment
Install new peel &stick roof underlayment
Install new Owne corning./duration shingle
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC E.Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing OSprinklers Generator Roof 5/12 Roof pitch
Total Sq.Ft of Constri.rction: 2188 S .Ft.of First Floor. 2188
Cost of Construction:$ 16,000 Utilities: ✓ Sewer Septic Building Height: 8
OWNER/LESSEE:: CONTRACTOR:. :
Name Willard L Gralia Name: Mauricio Orellana
Address:6815 Dickinson Terrace Company: One Construction&Roofing Contractors
City: Port Saint Lucie State:Fl Address: 2766 sw Edgarce st
Zip Code: 34952 Fax: City: Port Saint Lucie State:FI
Phone No.772-409-4242 Zip Code: 34953 Fax: N/A
E-Mail:N/A Phone No. 772-240-9497
Fill in fee simple Title Holder on next page(if different E-Mail: oneconstructionservices@yahoo.com
from the Owner listed above) State or County License: CCC-1330623
If value of construction is-$2500 or more,a"RECORDED Ndtice of Commencement is required.
_SUPPLEMENTALC-0 ST_RUCI!_ON LIEN LAUD INFORMATION w
DESIGNER/ENGINEER: X 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: game:
Address:2766-Edgme st 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 orprohibi€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 he first-inspection:ff you jntend to obtain-f nandng,-consult with1ender-or an-attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI A���\ STATE OF FLORI
COUNTY OF S� a COUNTY OF '�
The for oing instrument was acknowledged before me The f oing instr ment was acknowledge'�b` efore me
this�16 day of \)e C 2018 by this luday of V C 20 'U by
MaJ1.1 C,13 61 ,ACA.."-C'b b.-e ta- C'
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatign Type of Identif'catIV
Produced `t Produced I l
(Signature of Notary Pub ic- a ell Q ol` i a� "(Signature of Notary Pu ic-Stat o FIdfi'daa)
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Commission No. ��7 _� :°= °(Seale• fiMICSION 4 FF92.I Cbrmission No.
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EXPIRES Daco� EXPIRES
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17